Pharmacy in the Roman Empire.
The separation of the practices of medicine, pharmacy, and surgery, which became general though never universal, was of course a gradual process. Galen expresses the opinion that Hippocrates prepared the medicines he prescribed with his own hands, or at least superintended the production of them. According to Celsus, it was in Alexandria and about the year 300 B.C. that the division of the practice of medicine into distinct branches was first noticeable. The sections he names were Dietetics, Surgery and Pharmaceutics.
The physicians who practised dietetics were like our consultants, only more so. They were above all things philosophers, the recognised successors of the Greek thinkers and theorists, and but too often their imitators. Although they owed their designation to their general authority on régime, they prescribed and invented medicines. The pharmaceutical section came to be called in Latin medicamentarii, and their history corresponds closely with that of our English apothecaries. At first they prepared and administered the medicines which the physicians ordered. But in Alexandria and Rome they gradually assumed the position of general practitioners. To another class, designated by Pliny Vulnerarii, was left the treatment of wounds, and probably of tumours and ulcers. The necessity of a lower grade of medical practitioners in Rome is manifest from a remark of Galen’s to the effect that no physician, meaning a person in his own rank, would attend to diseases of minor importance.
It is worthy of note that the Latin designation medicamentarius, which was nearly equivalent to the Greek pharmacopolis, was similarly used to mean a poisoner, while pharmakon in Greek and medicamentus in Latin might mean either a medicine or a poison.
It is noted elsewhere (page [52]) that the word pharmakeia when it occurs in the New Testament is universally translated in our versions by the term sorcery or some similar word. At the time when the Apostles wrote this was evidently the prevalent meaning attached to the term. But in earlier Greek literature the reputable and the disgraceful ideas associated with the word seem to have run side by side for centuries. Homer uses pharmakon in both senses; Plato makes pharmakeuein mean to administer a remedy, while Herodotus adopts it to signify the practice of sorcery. Apparently this word came from an earlier, pharmassein, which was derived from a root implying to mix, and the gradual sense development was that of producing an effect by means of drugs. They might produce purging, they might produce a colour, or they might produce love.
The multiplication of names for the various classes connected with medicine and pharmacy in the Roman world is rather confusing. As the language of medicine up to and including Galen was largely Greek, many of the designations employed were those which had been drawn from that tongue. The name Pharmacopeus, used in Greek to denote certain handlers of drugs, had always a sinister signification. It suggested a purveyor of noxious drugs, a compounder of philtres, a vendor of poisons. The men who kept shops for the sale of drugs generally were called pharmacopoloi. This term was not free from reproach, because it was a common appellation, not only of the shopkeepers strictly so-called, but was also applied to the periodeutes, or agyrtoi, travelling quacks or assembly gatherers, or as they came to be named in Latin, circulatores or circumforanei.
These itinerant drug sellers are occasionally referred to by the classic authors. Lucian speaks of one hawking a cough mixture about the streets; and Cicero, in his Oratia pro Cluentio, suggests that the travelling pharmacopolists who attended the markets of country towns were not unwilling to sell poisons as well as medicines when they were wanted. One of these is specifically named, Lucius Clodius, and the orator suggests that he was bribed to supply medicines to a certain lady which were to have a fatal effect.
The designation Periodeutes meant originally, and always in strict legal terminology, physicians who visited their patients. The term was also used among the Christians to describe the ministers charged to visit the sick and poor in their dioceses.
The tramp doctor in time gets tired of his vagabond life, and, it may be, a little weary of hearing his own voice. If he has saved a little money, therefore, the attractions of a shop in the city, where he can exercise his healing on people who seek him, appeal strongly to him. So in Greece and in the Roman Empire the charlatans settled in little shops and were called iatroi epidiphrioi or sellularii medici, meaning sedentary doctors. But all these were pharmacopoloi.
Peculiarly interesting is the suggestion made by Epicurus and intended as a sneer, that Aristotle was one of these pharmacopoloi in his younger days. According to Epicurus the philosopher having first wasted his patrimony in riotous living and then served as a soldier, afterwards sold antidotes in the markets up to the time when he joined Plato’s classes.
Seplasia was the ordinary name in Rome for a druggist’s shop, and those who kept them were designated Seplasiarii or Pigmentarii. These names appear to have been used without much recognition of their original meanings. Strictly the Seplasiarii were ointment makers, and though the Pigmentarii were no doubt at first sellers of dyes and colours, they evidently came to include medicines in their stocks of pigments, and Coelius Aurelianus, in writing on stomach complaints, alludes to aloes as a pigment. Greek designations corresponding to those just quoted were Pantopoloi and Kadolikoi (the latter used by Galen in referring to the trader who supplied the drugs for the theriacum prepared in the palace of the Emperor Antoninus). Kopopoloi, and Migmatopoloi, both of which words meant dealers in all sorts of small wares, were like the mercers in this country when shopkeeping first began. The shops of perfumers were myropolia or myrophecia, the perfumers themselves were myrepsi. A general term in Latin for any sort of shop where medicines were sold or surgical operations performed was Medicina. This was in the days before the Empire, when there was no usual distinction between the branches of the healing art.
Pharmacotribae, strictly drug-grinders, may have been compounders, and it has also been conjectured that they were the assistants employed by the Seplasiarii or Roman druggists.
Herbalists were of very ancient Greek lineage, under the names of Botanologoi, who were collectors of simples, and who, to enhance the price of their wares, pretended to have to gather them with many superstitious observances; and Rhizotomoi, or root-cutters. The name Apothek, which came to be appropriated to the warehouse where medicinal herbs were kept, and which is to-day the German equivalent of our pharmacy, or chemist’s shop, meant originally any warehouse, and from it has been derived the French boutique and the Spanish bodega.
The earlier Greek and Roman physicians were in the habit of themselves preparing the medicines they prescribed for their patients. But naturally they did not gather their own herbs, and as many of those used for medicine were exotics, it is obvious that they could not have done so if they had wished. The herbalists who undertook this duty (botanologoi in Greek) developed into the seplasiarii, pharmacopoloi, medicamentarii, and pigmentarii already mentioned. Beckmann says they competed with the regular physicians, having acquired a knowledge of the healing virtues of the commodities they sold, and the methods of compounding them. This could not help happening, but it ought to be remembered that the physicians of all countries had themselves developed from herbalists, that is, if we abandon the theories of miraculous instruction which are found among the legends of Egypt, Assyria, India, and Greece.
How similar the relations of the doctors and druggists of ancient Rome were with those still prevailing in this country may be gathered from a reproach levelled by Pliny against physicians contemporary with him (Bk. xxxiv, 11) to the effect that they purchased their medicines from the seplasiarii without knowing of what they were composed.
VI
ARAB PHARMACY.
In the science of medicine the Arabians have been deservedly applauded. The names of Mesua and Geber, of Razis and Avicenna, are ranked with the Grecian masters; in the city of Bagdad 860 physicians were licensed to exercise their lucrative profession; in Spain the lives of the Catholic princes were entrusted to the skill of the Saracens; and the School of Salerno, their legitimate offspring, revived in Italy and Europe the precepts of the healing art.—Gibbon: “Decline and Fall of the Roman Empire,” Chap. LII.
No period of European history is more astonishing than the records of the triumphant progress of the Arab power under the influence of the faith of Islam. From the earliest times this grand Semitic race was distinguished for learning of a certain character, for gravity, piety, superstition, a poetic imagination, and eloquence. Centuries of independence, jealously guarded, and innumerable local feuds made the material of perfect soldiers, and when Mohammed had grafted on the native religious character his own faith and missionary zeal the Arab army, the Saracens, as they came to be called, filled with fanatic fervour, and utterly indifferent to death, or, rather, eager for it as the introduction to the Paradise which their prophet had seen and told them of, formed such an irresistible force as on a small scale has only been reproduced by Cromwell in our nation.
But the rapidity of the conquests of Mohammedanism was perhaps less remarkable than the extraordinary assimilation of ancient learning and the development of new science among these hitherto unlettered Arabs. Mohammed was born in the year 569 of our era. The Koran was the first substantial piece of Arabic literature. Alexandria was taken and Egypt conquered by the Moslems under Amrou in A.D. 640, Persia and Syria having been previously subdued. Amrou was himself disposed to yield to the solicitations of some Greek grammarians, who implored him to spare the great Library of the city, the depository of the learning of the ancient world. But he considered it necessary to refer the request to the Caliph Omar. The reply of the Commander of the Faithful is one of the most familiar of the stories in Gibbon’s fascinating history. “If the writings support the Koran they are superfluous; if they oppose it they are pernicious; burn them.” It is declared that the papers and manuscripts served as fuel for the baths of the city for six months.
The destruction of the Alexandrian Library is often alluded to as a signal triumph of barbarism over civilisation. Gibbon cynically remarks that “if the ponderous mass of Arian and Monophysite controversy were indeed consumed in the public baths a philosopher may allow with a smile that it was ultimately devoted to the benefit of mankind.” But at least the spirit which animated Omar in 640 may be noted for comparison with the encouragement of learning which was soon to characterise the Arab rulers.
Only a lifetime later, in A.D. 711, the sons of the Alexandrian conquerors invaded Spain, and within the same century made their western capital, Cordova, the greatest centre of learning, civilisation, and luxury in Europe. The following quotation from Dr. Draper’s “History of the Intellectual Development of Europe” will give an idea of this achievement:
Scarcely had the Arabs become firmly settled in Spain than they commenced a brilliant career. Adopting what had become the established policy of the Commanders of the Faithful in Asia, the Emirs of Cordova distinguished themselves as patrons of learning, and set an example of refinement strongly contrasting with the condition of the native European Princes. Cordova under their administration, at the highest point of their prosperity, boasted of more than two hundred thousand houses, and more than a million inhabitants. After sunset a man might walk through it in a straight line for ten miles by the light of the public lamps. Seven hundred years after this time there was not so much as one public lamp in London. Its streets were solidly paved. In Paris, centuries subsequently, whoever stepped over his threshold on a rainy day stepped up to his ankles in mud. Other cities, as Granada, Seville, Toledo, considered themselves rivals of Cordova. The palaces of the Khalifs were magnificently decorated. Those sovereigns might well look down with supercilious contempt on the dwellings of the rulers of Germany, France, and England, which were scarcely better than stables—chimneyless, windowless, with a hole in the roof for the smoke to escape, like the wigwams of certain Indians.
Interior of Mosque, Cordova.
About the same time the passion for learning was growing in the East. Bagdad was founded A.D. 762, and about the year 800 Haroun Al-Raschid founded the famous university of that city. Libraries and schools were established throughout the two sections of the Saracenic dominions. Greek and Latin works of philosophy and science were translated, but the licentious and blasphemous mythology of the classical poets was abhorred by this serious nation, and no Arabic versions of Olympian fables were ever made. Astronomy, mathematics, metaphysics, and the arts of agriculture, of horticulture, of architecture, of war, and of commerce, were advanced to an extent which this century does not realise, while amid all this progress the study of chemistry, medicine, and pharmacy was pursued with particular eagerness.
Curiously the Arabs owed their instruction in these branches of knowledge to those whom we are accustomed to regard as their traditional foes. The dispersion of the Nestorians after the condemnation of their doctrines by the Council of Ephesus in A.D. 431 resulted in the foundation of a Chaldean Church and the establishment of famous colleges in Syria and Persia. In these the science of the Greeks, the philosophy of Aristotle, and the medical teaching of Hippocrates were kept alive when they had been banished by the Church from Constantinople. The Jews had also acquired special fame for medical skill throughout the East, and they and the Nestorians appear to have associated in some of the schools. It was to these teachers the Arabs turned when, having assured their military success, they demanded intellectual advancement. The Caliphs not only tolerated, they welcomed the assistance of the “unbelievers,” and, in fact, depended on them for the equipment of their own schools, and for the private tuition of their children. To John Mesuë, a Nestorian, and a famous writer on medicine and pharmacy, Haroun Al-Raschid entrusted the superintendence of the public schools of Bagdad.
The first Nestorian college is believed to have been established in the city of Dschondisabour in Chuzistan (Nishapoor), before the revelation of Mohammed. Theology and Medicine were particularly studied at this seat of learning, and a hospital was established to which the medical students were admitted, but they had first to be examined in the Psalms, the New Testament, and in certain books of prayers.
It was the Caliph Almansor and his immediate successor, Haroun Al-Raschid, who between them made Bagdad a centre of study. Students and professors came thither from all parts of the then civilised world, and the Caliphs welcomed, and indeed invited, both Christians and Jews to teach there. Hospitals were established in the city, and the first public pharmacies or dispensaries were provided in Bagdad by Haroun Al-Raschid. It is on record that in A.D. 807 envoys from that monarch came to the court of Charlemagne bringing gifts of balsams, nard, ointments, drugs, and medicines.
Arabic medicine was based on the works of Hippocrates and Galen, which were for the most part translated first into Syriac, and then into Arabic. It does not come within the scope of this work to narrate or estimate the advance in medicine which may be accredited to the Arabian writers and practitioners. Medical historians do not allow that they contributed much original service to either anatomy, physiology, pathology, or surgery; but it is admitted by every student that their maintenance of scholarship through the half dozen centuries during which Europe was sunk in the most abject ignorance and superstition entitles them to the gratitude of all who have lived since. The medicine of Avicenna was perhaps much the same as that of Galen. Both were accepted by the physicians of England, France, and Germany with the slavish deference which the long burial of the critical faculties had made inevitable, and which needed the vigorous abuse of Paracelsus to quicken into activity.
Whatever may have been the case with medicine it cannot be denied that the Arabs contributed largely to the development of its ministering arts, chemistry and pharmacy. The achievements attributed to Geber in the eighth century were probably not due to any single adept. Tradition assigned the glory to him and, likely enough, if such a chemist really lived and acquired fame, other investigators who followed him for a century or two adopted the pious fraud so frequently met with in other branches of study in the early centuries of our era of attributing theories or discoveries to some venerated teacher in order to assure for them immediate acceptance. However this may be, it is not the less established that the chemistry of Geber, or of Geber and others, was in fact the fruit of Arab industry and genius.
Our language indicates to some extent what Pharmacy owes to the Arabs. Alcohol, julep, syrup, sugar, alkermes, are Arabic names; the general employment in medicine of rhubarb, senna, camphor, manna, musk, nutmegs, cloves, bezoar stones, cassia, tamarinds, reached us through them. They first distilled rose water. They first established pharmacies, and from the time of Haroun Al-Raschid there is evidence that the Government controlled the quality and prices of the medicine sold in them. Sabor-Ebn-Sahel, president of the school of Dschondisabour, was the author of the earliest pharmacopœia, which was entitled “Krabadin”; and Hassan-Ali-Ebno-Talmid of Bagdad in the tenth century, and Avicenna (Al-Hussein-Ben-Abdallah-Ebn-Sina) in the eleventh century prepared collections of formulas which were used as pharmacopœias.
It was the Arabs who raised pharmacy to its proper dignity. We do not read of any noted pharmacists among them who were not physicians, but the latter were all keen students of the materia medica, and occupied themselves largely with pharmaceutical studies. But it is evident that there was a distinct profession of pharmacy. We read of Avicenna, for example, taking refuge with an apothecary at Hamdan, and there composing some of his famous works. Elsewhere a quotation from Rhazes gives some indication of the irregular practice of medicine which has prevailed in every country and among all nations; and Sprengel quotes some translated items from various Arabic authors which show that as early as the ninth century the Government sanctioned the book of pharmaceutical formulas, compiled by Sabor-Ebn-Sahel, director of the School of Dschondisabour, already mentioned. His work was frequently imitated in later times. The first London Pharmacopœia was professedly based largely on the Formulary of Mesuë.
There is also evidence that both in civil life and in the army the pharmacists were closely supervised. Their medicines were inspected, and the prices at which they were sold to the public were controlled by law.
The development and progress of medicine and its associated sciences among the Arabs may be very concisely sketched. The flight of Mohammed from Mecca to Medina, the Hejira as it is called, from which the Mohommedan era is dated, corresponds in our chronology with A.D. 622. The prophet died in 632. Contemporary with him lived a priest at Alexandria named Ahrun or Aaron, who compiled from Greek writers thirty books which he called the Pandects of Physic. These were translated into Syriac and Arabic about 683 by a Jew of Bassora named Maserdschawaih-Ebn-Dschaldschal. It is not in existence, and is only known by references to it made by Rhazes. The first allusion to small-pox known to history was contained in these Pandects. Serapion quotes a number of formulas which he says were invented by Ahrun. In 772 Almansor, the Caliph who founded the city of Bagdad, brought thither from Nishabur (Dschondisabour) in Persia, a famous Christian physician named George Baktischwah, who stayed for some time, and at the request of Almansor translated into Arabic certain books on Physic. He then returned to his own land, but his son was afterwards a physician in great favour with the two succeeding Caliphs, Almohdi and Haroun Al-Raschid. Freind states that when the elder Baktischwah returned to Persia Almansor presented him with 10,000 pieces of gold, and that Al-Raschid paid the younger Baktischwah an annual salary of 10,000 drachmas. The last-named ruler also brought to Bagdad the Nestorian Christian, Jahiah-Ebn-Masawaih, who, under the name of Mesuë the Elder, retained a reputation for his formulas even up to the publication of the London Pharmacopœia.
Mesuë is noted for his opposition to the violent purgative medicines which the Greek and Roman physicians had made common, and he had much to do with the popularisation, if not with the introduction of, senna, cassia, tamarinds, sebestens, myrabolans, and jujube. He modified the effects of certain remedies by judicious combinations, as, for example, by giving violet root and lemon juice with scammony. He gave pine bark and decoction of hyssop as emetics, and recommended the pancreas of the hare as a styptic in diarrhœa.
A disciple of Mesuë’s, Ebn-Izak, added greatly to the medical resources of the Arabs by translations of the works of Hippocrates, Galen, Pliny, Paul of Egineta, and other Greek authors.
Abu-Moussah-Dschafar-Al-Soli, commonly called Geber, the equivalent of his middle name, is supposed to have lived in the eighth century. It has already been remarked that the chemical discoveries attributed to this philosopher were probably the achievements of many workers, and were afterwards collected and passed on to posterity as his alone. From him are dated the introduction into science, to be adopted later in medicine, of corrosive sublimate, of red precipitate, of nitric and nitro-muriatic acids, and of nitrate of silver.
These chemical discoveries must have been made within the hundred years from 750 to 850, because Rhazes, who wrote in the latter half of the ninth century, mentions them. Geber has been supposed to have claimed to have discovered the philosopher’s stone, and to have made the universal medicine. But it is not at all certain that he contemplated medicine at all. His language is highly figurative, and probably when he says his gold had cured six lepers he meant only that he had, or thought he had, extracted gold from six baser metals.
Rhazes, whose Europeanised name is the modification of Arrasi, which was the final member of a long series of Eastern patronymics, was of Persian birth, and commenced his studies in that country with music and astronomy. When he was thirty he removed to Bagdad, and it was not until then that he took up the sciences of chemistry and medicine. Subsequently he was made director of the hospital of Bagdad, and his lectures on the medical art were attended by students from many countries. His principal work was entitled Hhawi, which has been translated Continent, apparently because it was supposed to contain all there was to know about medicine. The style of this treatise is that of notes without method, and it is certain that it could not have been written entirely by Rhazes, as authorities are named who did not live until after he had died. The theory is that Rhazes left a quantity of notes of his lectures and cases, and that some of his disciples afterwards published them with additions, but without much editing.
Among the methods of treatment for which Rhazes is responsible may be mentioned that of phthisis, with milk and sugar; of high fever, with cold water; of weakness of the stomach and of the digestive organs, with cold water and buttermilk; and he advises sufferers from melancholia to play chess. He states that fever is not itself a disease, but an effort of nature to cast out a disease. He was particularly careful in the use of purgatives, which he said were apt to occasion irritation of the intestinal canal, and in dysentery he relied usually on fruits, rice, and farinaceous food, though in severe cases he ordered quicklime, arsenic, and opium. In Freind’s History of Medicine (1727) a translation of some comments of Rhazes on the impostors of his day shows better than the citations already given how just and, it may be said, modern were the ideas of this practitioner of more than a thousand years ago. It may be added that Freind is not very complimentary to Rhazes generally. I append an abbreviation of this interesting notice of the quackery of the ninth century.
There are so many little arts used by mountebanks and pretenders to physic that an entire treatise, had I mind to write one, would not contain them. Their impudence is equal to their guilt in tormenting persons in their last hours. Some of them profess to cure the falling sickness (epilepsy) by making an issue at the back of the head in form of a cross, and pretending to take something out of the opening which they held all the time in their hands. Others give out that they will draw snakes out of their patients’ noses; this they seem to do by putting an iron probe up the nostril until the blood comes. Then they draw out an artificial worm, made of liver. Other tricks are to remove white specks from the eye, to draw water from the ear, worms from the teeth, stones from the bladder, or phlegm from various parts of the body, always having concealed the substance in their hands which they pretend to extract. Another performance is to collect the evil humours of the body into one place by rubbing that part with winter cherries until they cause an inflammation. Then they apply some oil to heal the place. Some assure their patients they have swallowed glass. To prove this they tickle the throat with a feather to induce vomiting, when some particles of glass are ejected which were put there by the feather. No wise man ought to trust his life in their hands, nor take any of their medicines which have proved fatal to many.
Rhazes writes of aqua vitæ, but it is now accepted that he only means a kind of wine. The distillation of wine was not practised till a century after him. Mercury in the form of ointment and corrosive sublimate were applied by him externally, the latter for itch; yellow and red arsenic and sulphates of iron and copper were also among his external remedies. Borax (which he called tenker), saltpetre, red coral, various precious stones, and oil of ants, are included among the internal remedies which he advises.
Avicenna.
As represented on the diploma of the Pharmaceutical Society.
The Arab author who acquired by far the greatest fame in Western lands, and who, indeed, shared with Galen the unquestioning obedience of myriads of medical practitioners throughout Europe until Paracelsus shook his authority five hundred years after his death, was Al-Hussein-Abou-Ali-Ben-Abdallah-Ebn-Sina, which picturesque name loses its Eastern atmosphere in the transmutation of its two concluding phrases into Avicenna. This famous man was born at Bokhara in 980; at twelve years of age he knew the Koran by heart; at sixteen he was a skilful physician; at eighteen he operated on the Caliph Nuhh with such brilliant success that his fame was established. In the course of a varied life he was at one time a Vizier, and soon afterwards in prison for being concerned in some sedition. He escaped from prison and lived for a long time concealed in the house of a friendly apothecary, where he wrote a large part of his voluminous “Canon.” He spent the later years of his life at Ispahan, where he was in great favour with the Caliph Ola-Oddaula, and he died at Hamdan in 1038 in the fifty-eighth year of his age. He had led an irregular life, and it was said of him that all his philosophy failed to make him moral, and all his knowledge of medicine left him unable to take care of his own health.
Competent critics who have studied the medical teaching of Avicenna have not been able to discover wherein its merits have justified the high esteem to which it attained. The explanation appears to be that what Avicenna lacked in originality he made up in method. The main body of his “Canon” is a judicious selection from the Greek and Latin physicians, and from Rhazes and other of his Arabic predecessors. He wrote a great deal on drugs and remedies, but it has been found impossible to identify many of the substances of his Materia Medica, as in many cases the names he gives evidently do not apply to those given by Serapion, Rhazes, and other writers. He often prescribed camphor, and alluded to several different kinds; a solution of manna was a favourite medicine with him; he regarded corrosive sublimate as the most deadly of all poisons, but used it externally; iron he had three names for, probably different compounds; he had great faith in gold, silver, and precious stones; it was probably he who introduced the silvering and gilding of pills, but his object was not to make them more pleasant to take, but to add to their medicinal effect.
Serapion the younger, and Mesuë the younger, who both lived soon after the time of Avicenna, were principally writers on Materia Medica, from whose works later authors borrowed freely.
The subsequent Arab authorities of particular note came from among the Western Saracens. Albucasis of Cordova, Avenzoar of Seville, and Averrhoes of Cordova, who are all believed to have flourished in the twelfth century, were the most celebrated. Albucasis was a great surgeon and describes the operations of his period with wonderful clearness and intelligence. Avenzoar was a physician who interested himself largely in pharmacy. He was reputed to have lived to the age of 135 and to have accumulated experience from his 20th year to the day of his death. Averrhoes knew Avenzoar personally, but was younger. He was a philosopher and somewhat of a freethinker who interested himself in medical matters. We are naturally more concerned with Avenzoar than with the others.
It is evident from the books left by Avenzoar, whose full name was Abdel-Malek-Abou-Merwan-Ebn-Zohr, that in his time the practices of medicine, surgery, and pharmacy were quite distinct in Spain, and he apologises to the higher branch of the profession for his interest in those practices which were usually left to their servants. But he states that from his youth he took delight in studying how to make syrups and electuaries, and a strong desire to know the operation of medicines and how to combine them and to extract their virtues. He writes about poisons and antidotes; has a chapter on the oil alquimesci, which Freind renders oil of eggs, and Sprengel calls oil of dates. Avenzoar says his father brought it from the East, and that it was a marvellous lithontryptic. He tells how mastic corrects scammony, and sweet almonds colocynth. He is the earliest writer to refer to the medicinal virtues of the bezoar stones. He gives a different account of the origin of these stones from that of other authors. The best, he says, comes from the East and is got from the eyes of stags. The stags eat serpents to make them strong, and at once to prevent any injury their instinct impels them to run into streams and stand in the water up to their necks. They do not drink any water. If they did they would die immediately; but standing in the stream gradually reduces the force of the poison, and then a liquor exudes by the eyelids which coagulates and forms a stone which may grow to the size of a chestnut, which ultimately falls off. According to another Arab author, Abdalanarack, the bezoar stone acquired such a celebrity in Spain that a palace in Cordova was given in exchange for one.
Moses Maimonides, the most famous Jewish scholar and theologian of the middle ages, must be mentioned among the exponents of Arab pharmacy. He was born at Cordova in 1139, and studied medicine under Averrhoes, but when he was twenty-five the then Mohammedan ruler of Spain required him to be converted or quit the kingdom. Maimonides therefore went to Cairo, and became physician to Saladin, the well-known hero of Crusade wars, who was then Sultan of Egypt. Among his duties he had to superintend the preparation of theriaca and mithridatium for the Court. The drugs for these compounds, Maimonides says, had to be brought from the East and the West at great expenditure of time and money. Consequently, “the illustrious Kadi Fakhil,” (who was apparently one of Saladin’s ministers), “whose days may God prolong, ordered the most humble of his servants in 595 (A.D. 1198) to compose a treatise, small, and showing what ought to be done immediately for a person bitten by a venomous animal.” The treatise which Maimonides composed, in obedience to this order, he called “Fakhiliteh.” This small popular manual reflects in general the pharmacy of Spain and is of no particular interest. The author considers that for all kinds of poisons and venoms the most efficacious antidote is an emerald, laid on the stomach or held in the mouth; and he notes the virtues of theriaca, mithridatium, and of bezoar. But the Kadi was thinking of poor people, and therefore more ordinary remedies were also named. A pigeon killed and cut in two pieces might be applied to painful wounds, but if this was not available warm vinegar with flour and olive oil might be substituted. Vomiting must be excited, and to destroy the virus a mixture of asafœtida, sulphur, salt, onions, mint, orange-pips, and the excrement of pigeons, ducks, or goats, compounded with honey and taken in wine, was recommended. The wisdom of Rhazes, of Avenzoar, and of other great authorities was also drawn from.
VII
FROM THE ARABS TO THE EUROPEANS
“Mediciners, like the medicines which they employ, are often useful, though the one were by birth and manners the vilest of humanity, as the others are in many cases extracted from the basest materials. Men may use the assistance of pagans and infidels in their need, and there is reason to think that one cause of their being permitted to remain on earth is that they might minister to the convenience of true Christians.”—The Archbishop of Tyre in Sir Walter Scott’s Talisman.
It would require a very long chapter and would be outside the scope of this work to attempt to trace in any detail the manner in which the ancient wisdom and science of the Greek and Latin authors, which was so marvellously preserved by the iconoclastic Arabs, was transferred, when their passion for study and research began to fail, to European nations. It has been alleged that the Crusades served to bring the attainments of the Eastern Saracens to the knowledge of the West through learning picked up by the physicians and others who accompanied the Christian armies against the Mohammedans.
But there is no evidence and not much probability that Europeans acquired any Eastern science of value through the Crusades. Indirectly medicine ultimately profited greatly by the commerce which these marvellous wars opened up between the East and the West, and the diseases which were spread as the consequence of the intimate association of the unwholesome hordes from all the nations concerned, resulted in the establishment of thousands of hospitals all over Europe. The provision of homes for the sick was far more common among the Mohammedans than among the Christians of that period. Activity of thought was stimulated, and medical science must have shared in the effects of spirit of inquiry. Some historians have supposed that the infusion of astrological superstitions into the teaching and practice of medicine was largely traceable to the communion with the East in these Holy Wars: but this idea is not supported by anything that we know of the Arab doctors. “I have not found the union of astrology with medicine taught by any writer of that nation,” says Sprengel; and his authority is very great. On the other hand the philosophers and theologians of that age were only too eager to seize upon anything mystic, and plenty of materials for their speculations were found in the Greek and Latin manuscripts handed down to them. Superstitions entered into the mental furniture of the age much more directly from Rome and Alexandria than from Bagdad.
That the Arabs of the East could have taught their Christian foes much useful knowledge cannot be doubted. The letter from the Patriarch of Jerusalem to Alfred the Great (see page 131), for example, is proof of the pharmaceutical superiority of the Syrians over the Saxons at that time.
M. Berthelot has shown by abundant evidence in his “History of Alchemy” that the Latin works dealing with chemistry of the thirteenth, fourteenth, and fifteenth centuries which were very numerous in Christendom, were almost exclusively drawn from Arabic sources. Such chemical learning as the Arabs had collected from Greek writers, as well as that which they had added from their own investigations, in this way found its way back to the heirs of the original owners as they may be called.
We read likewise of Constantine the African, who, about the year 1050, came to Salerno after a long residence in the East, and gave to the medical school of that city the translations he had made from Arab authors. But, notwithstanding these evidences of Eastern culture, it is certain that the actual introduction of pharmacy into the Northern European countries is much more largely due to the Spanish Mohammedans. In the Middle Ages poor Arabs and Jews who had studied medicine in the schools of Cordova and Seville tramped through France and Germany, selling their remedies, and teaching many things to the monks and priests who, in spite of repeated papal edicts forbidding them to sell medicines, did in fact cultivate all branches of the art of healing, including many superstitions. The edicts themselves are evidence that they sold their services to those who could afford to pay for them.
The Medical School of Salerno, already mentioned, was the principal link between the later Greek physicians and the teaching institutions which remain with us to this day, as, for instance, the universities of Paris, Naples, Oxford, Padua, Vienna, and others of later fame. The origin of the school of Salerno is unknown, but it was certainly in existence in the ninth century. It was long supposed to have developed from a monastic institution, but it is now generally believed to have been always a secular school. Its historian, Mazza of Naples, 1681, quotes an ancient chronicle which names Rabbi Elinus (a Jew), Pontus (a Greek), Adala (a Saracen), and Salernus (a Roman) as its founders, but there is no evidence of the epoch to which this refers. Although other subjects were taught at Salerno, it became specially noted for its medical school, and in the ninth century it had assumed the title of Civitas Hippocratica. William of Normandy resorted to Salerno prior to his conquest of England, and a dietetic treatise in verse exists dedicated to his son Robert. It has been claimed that the works of Hippocrates and Galen were studied at Salerno from its earliest days, but so far as this was the case it was by the intermediary of Jewish doctors, who themselves derived their knowledge from Arab sources, that these were available. The original texts of the Greek and Latin authors were not in the hands of European scholars till Aldus of Venice began to reproduce them early in the sixteenth century.
The pharmaceutical knowledge to which the famous school attained may be judged by the reputation which attended the Antidotary of Nicolas Prepositus, who was director of the school in the first half of the twelfth century. In this Antidotary are found the absurd formulas pretending to have been invented or used by the Apostle Paul and others. “Sal Sacerdotale quo utebantur sacerdotales tempore Heliae prophetae” is among these. In the course of the next century or two medical students from England, Germany, Italy, and France went to Cordova, Toledo, and Seville, and there wrote translations of the medical works used in those schools. These translations by the end of the thirteenth century were so universally accepted as to eclipse Salerno, which from then began to decline in fame, Bologna, Montpellier, Padua, and Leyden gradually partitioning among themselves its old reputation. But the medical school of Salerno actually existed until 1811, when it was dissolved by a decree of Napoleon I.
As evidence of the monopoly of Avicenna in the medical schools of Europe at the beginning of the sixteenth century, and doubtless for a long period previously, the following from the preface to a Latin translation of the works of Paulus Egineta is quoted by Leclerc:—
Avicenna, who is regarded as the Prince and most excellent of all physicians, is read and expounded in all the schools; and the ninth book of Rhazes, physician to the Caliph Almansor, is similarly read and commented on. These are believed to teach the whole art of healing. A few later writers, such as Betruchius, Gatinaria, Guaynerius, and Valescus, are occasionally cited, and now and then Hippocrates, Galen, and Dioscorides are quoted, but all the other Greek writers are unknown. The Latin translations of a few of the books of Galen and Hippocrates which are in use are very corrupt and barbarous, and are only admitted at the pleasure of the Arabian Princes, and this favour is but rarely conceded.
The most notable event in the history of pharmacy after the earlier Crusades was an edict regulating the practice of both medicine and pharmacy issued by Frederick II, the Holy Roman Emperor and King of Sicily. This monarch, probably the ablest ruler in the Middle Ages, who died in 1250, had great esteem for Arab learning. Mohammedans and Jews were encouraged to come to Naples during his reign, and he facilitated by all means in his power the introduction of such innovations as had been acquired from Cordova and Bagdad.
The edict referred to mentions “apotheca,” meaning thereby only the warehouses where prepared medicines were stored. Those who compounded the medicines were termed “confectionarii,” the places or shops where they were sold were called “stationes,” and the persons who supplied them, “stationarii.” It is not quite clear whether the confectionarii and the stationarii were the same persons. Probably they were sometimes, but not necessarily always. Apparently the stationarii were generally the drug importers and dealers, and the confectionarii were the compounders. Both had to be licensed by the Medical School of Salerno; and among the duties imposed upon the physician, one was to inform the authorities if he came to discover that any “confectionarius” had falsified medicines. Longfellow alludes to this provision in the “Golden Legend”—
To report if any confectionarius
Mingles his drugs with matters various.
The physician was strictly forbidden to enter into any arrangement with a druggist whereby he would derive any profit by the sale of medicaments, and he was not permitted himself to conduct a pharmacy. The “confectioners” were required to take an oath to prepare all medicines according to the Antidotary of the Salernian School. Their profits were limited and graduated, less being allowed on those of frequent consumption than on those which they had to keep for more than a year. Pharmacies were only allowed in the principal cities, and in each such city two notable master-apothecaries were appointed to supervise them. The “confectioners” had to make their syrups and electuaries and other compounds in the presence of these two inspectors, and if they were detected in any attempt at fraud their property was subject to confiscation. If one of the inspectors was found to have been a party to the fraud his punishment was death.
“It is well known,” says Beckmann in “Ancient Inventions,” “that almost all political institutions on this side the Alps, and particularly everything that concerned education, were copied from Italian models. These were the only patterns then to be found; and the monks despatched from the papal court saw they could lay no better foundation for the Pontiff’s power and their own aggrandizement than by inducing other States to follow the examples set them in Italy. Medical establishments were formed, therefore, everywhere at first according to the plan of that at Salerno. Particular places for vending medicines were more necessary in other countries than in Italy. The physicians of that period used no other drugs than those recommended by the ancients; and as these had to be procured from the Levant, Greece, Arabia, and India, it was necessary to send thither for them. Besides, herbs, to be confided in, could only be gathered when the sun and planets were in certain constellations, and certificates of their being so were necessary to give them reputation. All this was impossible without a distinct employment, and it was found convenient to suffer dealers in drugs gradually to acquire monopolies. The preparation of medicines was becoming more difficult and expensive. The invention of distillation, sublimation, and other chemical processes necessitated laboratories, furnaces, and costly apparatus; so that it was thought proper that those who devoted themselves to pharmacy should be indemnified by an exclusive trade; and monopolists could be kept under closer inspection so that the danger of their selling improper drugs or poisons was lessened or entirely removed. They were also allowed to deal in sweetmeats and confectionery, which were then great luxuries; and in some places they were required to give presents of these delicacies to the magistrates on certain festivals.”
This extract shows how the German provision of protected pharmacy originated. In many of the chief cities the apothecaries’ shops were established by, and belonged to, the King or Queen, or the municipality. Sometimes, as at Stuttgart, there was a contract between the ruler and the apothecary, the former agreeing to provide a certain quantity of wine, barley, and rye; while the apothecary in return was to supply the Court with its necessary confectionery.
The Reproduction of a Sixteenth Century Pharmacy in the Germanic Museum at Nuremberg.
Beckmann gives much minute information concerning the establishment of apothecaries’ shops in the chief cities of Germany.[1] He mentions a conjecture that there was a pharmacy at Augsburg in the thirteenth and fourteenth centuries, but exact dates begin with the fifteenth century. There was a female apothecary established at Augsburg in 1445, and the city paid her a salary. At Stuttgart, in 1458, Count Ulric authorised one Glatz to open a pharmacy. There was one existing at Frankfort in 1472. The police regulations of Basle in 1440 mention the public physician and his duty, adding that “what costly things people may wish to have from the apothecary’s shop they must pay for.” The magistrates of Berlin, in 1488, granted to one Hans Zebender a free house, a certain provision of rye, no taxes, and the assurance that no other apothecary should reside in the city. But the Elector Joachim granted a new patent to another apothecary in 1499. At Halle there was only one apothecary. In that year the Archbishop, with the confirmation of the Chapter, granted to his physician, von Wyke, the privilege of opening another, but gave at the same time the assurance that no more should be permitted in the city “to eternity.”
In France apothecaries were in business as such certainly before 1250. A charter of the church of Cahors, dated 1178, describes the retail shopkeepers of the town as “apothecarii,” the term being used evidently as “boutiquiers” is now, and signifying nothing more than shopkeepers. The meaning, however, soon became restricted to dealers in drugs and spices. In the middle of the next century John of Garlande alludes to “appotecarii,” who sold confections and electuaries, roots and herbs, ginger, pepper, cumin, and other spices, wax, sugar, and licorice. Officially, however, these tradesmen were classed at that time among the “espiciers.” The two guilds, indeed, continued in formal association until 1777, but royal ordinances of 1484 and 1514 clearly established the distinction between them. Even in 1271 the Faculty of Medicine of Paris forbade “herborists and apothecaries” to practise medicine. Special responsibilities, duties, and privileges were expressly provided for the apothecaries, and in the ordinance of 1514 it is specifically declared that though the apothecary is always a grocer, the grocer is not necessarily an apothecary. (“Qui est espicier n’est pas apothicaire, et qui est apothicaire est espicier.”)
In the fourteenth century the apothecaries of Paris were required to subscribe to a formal oath before they were permitted to practise. They swore to live and die in the Christian faith, to speak no evil of their teachers or masters, to do all in their power for the honour, glory, ornament, and majesty of medicine, to give no remedy or purge without the authority of a physician, to supply no drugs to procure abortion, to prepare exactly physicians’ prescriptions, neither adding, subtracting, nor substituting anything without the express permission of the physician, to avoid the practices of charlatans as they would the plague, and to keep no bad or old drug in their stocks. An ordinance of 1359 provides that no one shall be granted the title of master-apothecary unless he can show that he can read recipes.
The edict of 1484, issued during the minority of Charles VIII, sets forth that, “We, of our certain science, especial grace, full power, and royal authority, do say, declare, statuate, and ordain” the curriculum to be observed by those who desire to learn the trade of an apothecary. A four years’ apprenticeship was essential, and the aspirant had to dispense prescriptions, recognise drugs, and prepare “chefs d’œuvres” in wax and confectionery in the presence of appointed master-apothecaries. Latin was added to the examination in 1536, and ten years’ experience after the apprenticeship was also insisted upon ultimately before the candidate could be admitted as a master-apothecary. One of the ordinances of the sixteenth century gave to the apothecaries the monopoly in the manufacture and sale of gingerbread.
These edicts all related particularly to the apothecaries of Paris. There were similar ones in the provinces, with some peculiarities. At Dijon, for example, it was provided that no apothecary could receive a legacy from one of his clients. En revanche he had the first claim on the estate of a deceased debtor for the payment of his account.
In 1629 the Hotel de Ville of Paris granted to the apothecaries of that city a banner and blazon, the latter, which I do not venture to translate, being thus described:—“Couppé d’azur et d’or, et sur l’or deux nefs de gueulle flottantes aux bannieres de France, accompagnés de deux estoiles a cinq poincts de gueulle avec la devise 'Lances et pondera servant,’ et telles qu’elles sont cy-dessous empreinctes.”
In 1682, under Louis XV, after the Brinvilliers panic, the poison register was introduced, and regulations were framed forbidding apothecaries to sell any arsenic, sublimate, or drug reputed to be a poison except to persons known to them, and who signed the register stating what use they intended to make of their purchase. Earlier in the same reign the practice of pharmacy was strictly forbidden to persons professing the reformed religion.
The last of the royal edicts applying to pharmacy was issued in 1777 by Louis XVI, and, as already stated, this was the authority which finally separated the apothecaries from the grocers. Then came the Revolution, and in 1791 all restrictions on trades or professions, including pharmacy, were abolished. Some accidents having occurred, the Assembly passed an ordinance on April 14, 1791, declaring that the old laws, statutes, and regulations governing the teaching and practice of pharmacy should remain in force until a new code should be framed. This did not appear until April, 1803, under Napoleon’s Consulate, and the law, which is still in force, is to this day cited in legal proceedings as the law of Germinal, year XI.
VIII
PHARMACY IN GREAT BRITAIN.
For none but a clever dialectician
Can hope to become a great physician:
That has been settled long ago.
Logic makes an important part
Of the mystery of the healing art;
For without it how could you hope to show
That nobody knows so much as you know.
—Longfellow: “Golden Legend.”