The profession of the pharmacist
print this pageIn the Compendium aromatariorum by Saladino d'Ascoli, from the mid-fourteenth century, ethical standards for the conduct of Pharmacists were established. He must be educated in order to well interpret the recipes and the scientia medicinae. He must not be too young, arrogant or conceited, nor a womanizer, "mulieribus deditus" (a wife was instead recommended). He must refrain from gambling, wine, parties, and should be quite "studiosus, solicitus, placabilis, & honestus, timens Deum, et conscientiam suam. Sit rectus, iustus, pius, et maxime ad pauperos... quia habet tractare de vita hominum", that is, the most important thing in the world. (c. 252r). He must not speculate on the price, not administer neither for love, for fear nor for money, abortive or poisonous medicines, not adulterate, for example by using honey instead of sugar. The importance of professional ethics runs through the history of pharmacy, though in the mid-eighteenth century, Donzelli seemed to repeat the words of Saladino: "La Farmacia ricerca esser officiata da un Uomo sedulo, sobrio, puntuale, letterato, ed odioso dell'immondezze, ne' medicamenti, ne' vasi, e in tutta l'officina, a cui assistono queste trè principali, ed essenziali condizioni, posse, velle, & scire" (The Pharmacy should be run by a Man who is diligent, sober, punctual, literate and who detests filth in medicaments, in jars and in the entire workshop; he is supported by three main and essential characteristics, posse, velle, & scire, power, desire, and knowledge) (p. 17).
The long-established distinction between physicians and pharmacists, already emphasised by Saladino: the latter cannot replace the first in suggesting remedies or substituting prescribed medications.
Affirmation of the role of the pharmacist is described in a pamphlet from 1786, some ideas about pharmacy reform by Salvator Mandruzzato (1758-1837), Paduan thermalist physician, then professor of pharmaceutical chemistry. The author gives an example from the history of Venice. The Most Serene Republic recognises the importance of the guild "where for some time, there has been a wish that those intending to profess Pharmacy, should be subject to an exam [1480, date in a note], to visit Apothecaries [1437] to study the medicaments, to allow Apothecaries to be separated from other trades of Grocers, Confectioners, etc. [1365] and to be able to be associated with the creation of a College, providing them more privileges" (p. 28). In Venice, the College of Apothecaries was founded in 1565, while the official regulatory organ since 1258 were the Magistrates of Ancient Justice, from 1485 the Superintendents of Health, which authorised the operation of pharmacies following examination and experience of at least eight years, and making annual checks on compliance regarding the compositions and tariffs, under penalty of having the materials burnt in Rialto. Elsewhere, the College of Pharmacists surfaced before that of physicians: in Padua, for example, in 1260. In the late-sixteenth century, Venice had also set minimum distances between pharmacies.
Mandruzzato called for a reform in three ways: "The means therefore to promote this Science, and to remove it from ignorance and deceit, can be reduced to three; which are, the establishment of a reasoned Pharmacopoeia; the training of good Masters; and distancing itself from Charlatanism" (p. 14).
The pharmacopoeia, i.e. the official list of eligible drugs, against the "farrago of composed medicines" (p. 19), was a need felt in Venice. Elsewhere, the first pharmacopoeias were issued three centuries earlier. Mandruzzato drafted the structure: a small treatise on materia medica with instructions on the preparation of simples, a compendium of operations of the recent "Theory of Chemistry", a list of medicaments of the profession reduced to a few, simple preparations, the table of chemical affinities to avoid harmful interactions, and the list of work instruments and regular updates of newly approved drugs. The new pharmacopoeia of the Venice Medical College came out four years later following the wishes of Mandruzzato, in 1790, but, ironically, it was so full of errors that it was immediately withdrawn.
The second means for pharmacy reform were good teachers: "If good books were enough to prepare learned men", the author seems to lament, "ma egli è certo... che non vi sia arte veruna, la quale apprender si possa dai soli libri senza maestro e senza esercizio" (but he is sure that there is no art at all that can be acquired only by books and without a master and without practicing) (p. 32). The institution of the practicum was ancient and had been taking place also in Venice since 1485 before the official examination.
The last means of pharmacy reform, according to Mandruzzato, was identifying the specific skills for working in the profession: the pharmacist is different from the physician, leaving to him the responsibility for diagnosis and prescription. The pharmacist needs, however, the scientific training to know how to read the physician’s prescriptions to avoid errors. At the same time, even the physician needs not to arrogate the pharmacist’s responsibilities, including those of chemistry. The pharmacist must also stand out from the charlatan; in particular, grocers must run a distinct business and should not sell medicines. To avoid confusion of the roles and initiating false competition, the pharmacist should maintain fair prices of his products. The updated training of pharmacists requires that the field be rid of old theories, those of temperaments and humours, or those working for superstitious analogies such as the doctrine of signatures of plants, which was supposed to cure the organ which it resembles in shape. The pharmacist must understand chemistry "that we have recently known" (p. 12), and, for the choice of simples, the "study of Botany, and systematic Natural History included in the Materia Medica" (p. 13).
Another pamphlet on the professional role of the pharmacist has a decidedly political angle: Del farmacista, dei suoi doveri e diritti by Bartolomeo Biasoletto (1793-1859). The opening is clear: "Since every citizen… is called in his industrial sector to participate in the new political organisation which is now being activated on constitutional grounds", the pharmacist must also do this (p. 1). With a paternalistic vision, the pharmacist was also expected to spread his knowledge by supporting the ignorant masses, for example, by giving advice to the farmer about soil composition, or to the tanner on chemical means useful to his profession, and thus "contribute to the advancement of industry and prosperity of the State" (p. 2). The vision of the State was also paternalistic, with its supreme right/duty to protect its members, who in turn contribute to the overall prosperity: "The duty of the pharmacist must be principally for the common good ... The pharmacist is therefore, strictly speaking, a public servant" (p. 5). For this reason, the state will assess the skills of the pharmacist and will prevent him from making a personal profit from his service. The professional career should include study, apprenticeship, public examination, practice for at least two years and further studies for two years at university including mathematics, physics, chemistry, mineralogy, botany, zoology, pharmacognosy and technology. To protect the seriousness of the profession, the state establishes an adequate salary, by adding a percentage to the price of drugs, defines the minimum distance between pharmacies and supervises their businesses. There is also an ethical appeal: aspiring pharmacists "should be equipped with moral integrity with physical qualities of body and of spirit" (p. 8).