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Chapter 2 – The ancient Egyptians, the Greeks and the Romans

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To trace the history of pharmacy and pharmaceutical preparations from the time of the Pharaohs of Egypt up to the present day, we have a series of Egyptian documents. These include the Kahun Papyrus of 2000 B.C., which dealt with veterinary medicines, the Edwin Smith and Hearst Papyri, and the Lesser Berlin Papyrus, which dated from about 1600 B.C.

The Ebers Papyrus, which is perhaps the most remarkable of these scrolls. The history of this papyrus, which was composed about 1552 B.C., is interesting. It was purchased by Georg Ebers, a German Egyptologist, from an Arab in Luxor, who claimed to have found it between the knees of a mummy excavated at Theba. The papyrus itself is in the form of a scroll 22 yards long, and about 12 inches wide, and it actually corresponds to a modern formula book or collection of recipes, in the compounding of which, something like 700 drugs are mentioned. Many of these are in use today, while others are entirely unknown, or at least we have been unable to trace the vague and in many cases fanciful names given to them. Some of the drugs or preparations named are as follows:-Wine, beer, yeast, vinegar, turpentine, figs, castor oil, myrrh, mastic, frank-incense, wormwood, aloes, opium, peppermint, cassia, anise, caraway, coriander, fennell, saffron, linseed, juniper berries, gentian. colchicum, squill, honey, grapes and in fact, pages could be filled in the enumeration of other well-known drugs.

Although these preparations are given the name in use today, it must not be assumed that the Egyptologists who deciphered the hieroglyphics found the task so easy. For example, Squill was known under the fanciful name of “The Eye of Typhon.”, wormwood was “The Heart of Bubastis,” fresh dill juice as the “Blood of the Ibis” and so on, rendering the task of interpretation exceedingly difficult, and in some cases impossible:

Besides the vegetable products a fair number of mineral compounds were in use, and included such things as iron. lead, bitumen, magnesia, nitre, vermillion, copper sulphate, common salt, etc. Finely powdered precious stones such emeralds and sapphires were also used m the treatment of diseases. The animal drugs used were very crude, and in many cases revolting. Imagine being obliged to keep stocks of lizard’s blood, swine’s teeth, putrid meat and fat, goose grease (although this is included in some recent foreign pharmacopoeias) asses’ hoofs, and excreta of various animals, including human beings, donkeys, dogs, cats, and even flies. One of the items to be found on a modern pharmacy shelf is psyllium, a fibrous seed used by the ancient Egyptians for its laxative and antidiarrhoeal properties. Today it is known by the brand name Metamucil.

A prescription prepared for the Pharoah Ra by the high priest of Egypt, Isis, contained coriander, worm-wood, juniper,honey and opium. and was used for headache. It probably depended for its efficacy upon the amount of opium present, which would certainly cure a headache.

From the foregoing it can be seen that the ancient Egyptians possessed quite a considerable degree of pharmaceutical lore, and their writings tell us that they could supply infusions, decoctions, macerations, inhalations, garg1es, poultices, and in fact practically the same type of preparations the older pharmacists of today, would still recognize. The Egyptians also used mortars of wood or stone, and used containers of pottery and glass.

Egypt produced the longest enduring of the early cultures which arose in the near East in fertile valleys which supported abundant life. In circumstances of comparative ease and prosperity human societies were able to enlarge and individuals to develop special roles within society.

Organisation of towns and cities was possible only with parallel social structures which brought with it the development of characteristic artistic styles and cultural values which we can still recognise over the gap of several millennia.

The pyramids which still stand over their graves show the power and prosperity of the Pharoahs. The funereal goods, paintings, and their embalmed bodies provide a picture of life in a self-sufficient society dominated physically by the River Nile and mentally by the cult of the dead.

From 3000BC and before, Egypt developed an advanced technological civilisation with skilled metallurgy, the making of papyrus and the recording of events and ideas in hieroglyphics, as well as efficient irrigation for agriculture. Egypt traded and occasionally made war with her neighbours both in the eastern Mediterranean and in Africa.

Although we may ridicule many of the beliefs of the early Egyptians, especially with regard to their belief in the efficacy of invocation in the treatment of disease, yet even now we preface all prescriptions with the Rx sign, which is traceable to the Pagan sign for Jupiter, and was used as an invocation to the gods by the Chaldean physicians when writing their prescriptions thousands of years ago.

RX symbol

RX symbol

This is one of the symbols that links pharmacy practice today to ancient mythology, and which appears on every prescription that you too will handle.  The Rx can take many forms, but they all basically have the same intent. The most popular interpretation is that it could have derived from the ancient Egyptian eye symbol, the Eye of Horus, the falcon god of lower Egypt who had his eyes torn out in a dispute. Each piece of the eye symbol represents a fraction, and these pieces were used when specifying the quantities of ingredients in a prescription, and when the pieces are put together we get the prescribing sign Rx.

There is a less fanciful interpretation however, and that is that Rx is an abbreviation for the Latin verb “recipere”, which translated means “Take” (it or thou). Hence it became the heading for the formula or prescription that followed. The English word recipe is derived from it and is taken to mean a list of ingredients and directions for making something, especially a food preparation.

All professions generate pictorial representations of their craft, including the health professions, who have generated a series of craft specific symbols. For Pharmacy the symbol is the bowl of Hygeia and the serpent reaching up to it, for Nursing it is a lamp, for Medicine it is the Caduceus, and so on.

Ancient Chinese Medicine

Pharmaceutical knowledge at this period was not confined to the Egyptians. The Chinese had their-Pun Tsao or Great Herbal, which was an extremely interesting manuscript. It enumerates 150 separate and particular hells, and it is significant that one is reserved for physicians and another for pharmacists; also, the thirteenth hell was one in which the victims were forced perpetually-to swallow hot and disagreeable concoctions. Some of the remedies described in this book are toad’s eyelids for colds, and earthworms rolled in honey for gastritis.

Ancient Greece

Many modern philosophical ideas concerning the nature of the universe and the rights and needs of the individual and the structure of society have their genesis in Classical Greece. The plays,narrative poems and particularly the myths and legends about their Gods and ancestors still speak to us about the meaning of life.

Greek statue

Asklepios

In medicine the Greeks made two giant steps, expressed in the writings of Hippocrates. Firstly they began to look for natural causes and effects in producing disease, and secondly they produced the first clearly recognisable descriptions of diseases and epidemics. These first steps in scientific medicine existed side by side with belief in divine powers of the oracles and priests to treat illness.  Less directly the methods of thought expounded by Greek philosophers like Socrates, Plato and Aristotle began the escape from the power of the supernatural which allowed the development of Western science. The Greek world also encouraged the geographical concentration of scholars and books, for instance in the great libraries at Alexandria and Pergamon.

Beginning in the 7th century BC, Greek legend has it that a god named Asklepios gradually superseded Apollo as the greatest of the healing gods and it was the centaur Chiron who taught Asklepios hisknowledge of drug plants. Sanctuaries devoted to healing the sick were erected all over Greece, wherein dwelt the kindly but powerful spirit of Asklepios, aided by his two daughters Hygeia and Panacea. whose names still appear in modern medicine?

Staff of Asklepois

Staff of Asklepois

It is the staff of Asklepios that has become the official symbol of medicine all over the world. It is based on the caduceus or wand carried by Mercury who was the messenger of the Gods. The entwined serpents represent Asklepios, and when he was slain by Zeus, his daughter Hygeia became the goddess of health. The depiction of the serpent reaching up to touch the bowl, is the father handing up the healing work to his daughter. It also represents the coming together of Medicine and Pharmacy.

Hygeia’s bowl, or patera, was originally used in religious ceremonies of ancient Greece and Rome as offerings to the goddess of health, and its origin can be traced back to the mortars used to compound medicinal herbs in pre literate neolithic times.  Many Pharmacy organisations use the bowl and serpent symbol, including PSA which has stylised the symbol as its motto (right).

From another period in Greek history unrelated to the mythology of the Gods, perhaps the greatest name that is still with us today is that of the physician Hippocrates, known as the father of medicine. He lived around 460 to 370 BC. In his writings, which are believed to have been done by many contributors, some 200 to 400 drugs are mentioned, as well as methods of carrying out various pharmaceutical processes.

Another great from this golden age of Greek culture was Galen. He practised and taught in Rome as a physician and natural scientist, in the second century AD. He created a system of pathology and therapy that ruled western medicine for 1500 years. It is from his name that the word ‘galenical” is derived.. It is to him also that we owe the formula for Cold Cream of Roses, which in a slightly altered form appeared in the 1932 British Pharmacopoeia under the name of Ung. Aquosum. He was a very prolific writer, being credited by some with having written as many as 500 works, His influence stayed with pharmacists until as late as the sixteenth century, and it may be mentioned in passing that he shared with our modern specialist, Sir Arbuthnot Lane, the belief that wines were of great value in medicine, although he further stipulated that to be of benefit they required to be matured for at least seven years.

The Roman Empire

The story of the legendary foundation of Rome in 753 BC by Aeneas and his band of refugees from Troy is told in the Aeneid. Rome grew from a precarious beginning to found and maintain an empire which spread around the shores of the Mediterranean and penetrated as far north as the Scottish border, deep into Africa and west into Asia Minor. The Romans were great administrators with a sense of civic obligation and honour, which still influences modern law.

Modern highways still follow the routes of the network of roads and bridges which they built to maintain communication between the different provinces of the empire, and their methods of construction were so sturdy that the basic stonework of many bridges, aqueducts, temples and arenas survived the vicissitudes of the European dark ages and the ravages of subsequent development to become present day tourist attractions.

The eastern, most populous and wealthiest half of the empire was Greek speaking. In the arts and sciences, and particularly in medicine, Greeks remained influential. The distinctively Roman contribution lay in the compilation of compendia of knowledge. The works of Galen, himself a Greek, are a good example. The Romans engineering skills were employed to provide clean water supplies to their cities and to erect public baths. Military discipline ensured an elaborate system of health care for the army, including appointment of military surgeons and provision of hospitals

The decline of the Roman Empire began almost as it reached its zenith under Augustus. Successive emperors, some honourable like Marcus Aurelius, some notorious, like Nero, shared the difficulty of maintaining power over such a vast and diverse empire.

Roman statuesIn the 5th Century AD the old pagan deities of medicine were replaced by two of the most celebrated patron saints of medicine and pharmacy, Damian & Cosmos, Damian representing divine guardianship over the services of the pharmacist. There will be occasions in your careers when a brief lapse in concentration results in an error which is detected just before the patient receives the medication and you thank your “guardian angel”. Actually you are thanking St.Damian.

If you look at a drawing or picture of a really old pharmacy you often see some very strange animal forms hung around the walls and ceilings. Things like stuffed crocodiles or tortoise shells and bunches of herbs or other plants all gave the place a fantastic appearance to attract customers.

Shakespeare in his Romeo and Juliet described an apothecary as a man in tattered weeds with overwhelming brows and sharp misery had worn him to the bones. In his needy shop a tortoise hung. An alligator stuffed, and other skins of ill shaped fishes.

Thankfully these are some symbols that have disappeared.

Passing over the intervening years, we come to the sixth century, when we find such drugs as rhubarb, can-tharides and colchicum being used by one Alexander of Tralles. Later we have books such as those writen by Rhazes, head of the Bagdad Hospital, and author of many important pharmaceutical works. Later still, about the middle of the tenth century, a number of books appeared, among them being several herbal lists, one dealing with leeches, and a Saxon book of recipes. In the year 1042 the rites of the Royal Touch as a cure for the scrofulous disease called King’s Evil were intro-duced, and in slightly altered form continued in the favour of the populace, if not of the kings, until late in the 18th century.

The intertwined role of the physician, herbalist, and priest is found throughout the early history of pharmacy. It was in the Middle Ages that these roles started to diverge. In 1240, the German Emperor Frederick II issued an edict that essentially separated the practice of medicine and pharmacy, giving rise to the professional pharmacy. In addition, the edict provided official supervision of pharmacy practice and ordered pharmacists to prepare drugs “reliably, according to skilled art, and in a uniform, suitable quality.”

In the year 1178 the word “apothecary” first occurs in French records, while 45 years later the first apothecary shop in Germany was opened in the town of Wetzlar. About this time, incidentally, an Englishman, Roger Bacon, foretold the coming of aeroplanes; submarines and automobiles and in 1270 he wrote the earliest recorded formula for gunpowder.

Just previous to this last date Arnold of Villanova had been experimenting with alcohol as a means of extracting active principles of drugs, and he is responsible for our earliest tinctures. Another era is marked by the passing of the first Poison Acts in Scotland in 1408 by order of James I. The most striking figure in the following century was Paracelsus, who was born in Switzerland, the son of a physician. He denounced the practice of relying on the works of long-dead writers, such as Galen, and very wisely stated that “Experience must verify what can be accepted or not accepted.” He was also noted for his denunciation of alchemy, and was responsible for many new ideas which have been adapted by later pharmacists. He stands out in history as being probably the greatest iconoclast of all time, and that in an age when to go against the old ideas was absolute heresy.

The Renaissance

The rebirth of European culture following the Black Death and its aftermath had two main strands. Firstly the ideas of the classical world of Greece and Rome were rediscovered, often literally from Greek Byzantine sources or through translations which had been made during the medieval period in Arabic centres of learning, but also from manuscripts safely kept and copied in the libraries of the monasteries since the fall of Rome. Secondly Europeans began to explore the world. Marco Polo ventured eastwards overland to China, while Columbus and the Portuguese, Dutch and English navigators opened sea routes around the world. This brought the isolation of the different cultures of Asia, Africa and America to an end.

The spread of ideas throughout Europe during the Renaissance was made possible by the invention of printing, and in medicine and pharmacy this made textbooks widely available for the first time. It also encouraged the spread of literacy and the fast popular works began to appeal , many of these were compendia of folk medicine and other advice in “Almanacs”.

The Age of Enlightenment

The Age of Enlightenment retained the intellectual curiosity of the Renaissance, but lacked its excitement and rigour. The universe and man himself were both regarded as intricate machines which could be analysed and understood in mathematical terms. This approach was brilliantly successful in astronomy and mapping, but less so in biology. However the passion for collecting and classifying did result in much better delineation of specific diseases. Often when we read case records of this time we can still recognise the disease, and these collections of cases became the basis for the first modern textbooks of medicine. Although the standard of diagnosis was improved, treatment lagged far behind. At this time, however, doctors began to assess the efficacy of treatments administered to a series of patients with the same disease. The old herbals and formularies from medieval times fell into disuse, and more authoritative works called Pharmacopoeias began to be produced The elegance of the participants in high society contrasted with the political and social realities of life for the majority of Europe’s growing population. Few could afford the services of a doctor at all, and the chemists and druggists, as well as the Apothecaries provided primary health care to the bulk of the population.

In England the physicians with their Royal Charter maintained an image of intellectual and social superiority above the surgeons and apothecaries. Despite the many advances in understanding the anatomy and physiology of the human body, the medical profession was as just as powerless when the Great Plague of 1665 struck London, as the medieval doctors had been.

In the 15th century, the trade in drugs and spices was a very lucrative pursuit and saw many conflicts between the Spanish, the Portuguese and the Dutch in their efforts to control the sources of these prized commodities. The British came onto the scene later, but the trade itself was largely in the hands of the Gild of Pepperers. After this the Spicers, the Pepperers, the Cullers and the Oil Sellers combined to form the Grocers Company and those who traded in medicines and drugs were also part of this Company.  (See Chapter 3)

This item is listed in the following categories: • Short introduction to history of pharmacy


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