Thursday, August 23, 2018
Are you familiar with the following interesting facts about pharmacy?
1. Coca-Cola was invented by a pharmacist named John Pemberton. He carried the jug of the new product down the street to Jacob's Pharmacy where it was sampled and pronounced "excellent" and placed on sale for 5 cents a glass as a soda fountain drink.
Another pharmacist, Charles Alderton, invented Dr. Pepper. Pepsi was also invented by a pharmacist, as was Vernor’s Ginger Ale by Detroit pharmacist James Vernor.
2. The first licensed pharmacist set up shop in the French Quarter. Louis Dufilho Jr. of New Orleans became American’s first licensed pharmacist in the early 1800s. Prior to then, you did not need a license to become a pharmacist.
3. The global pharmaceuticals market is worth $300 billion.
4. Benjamin Franklin was a pharmacist, while Agatha Christie was a pharmacy technician.
5. Lipitor is the best-selling drug of all time. It was introduced in 1997 and its patent expired in 2011, making about $125 billion.
6. Insulin is one of the most common medications that cause adverse events.
7. Hydrocodone/acetaminophen is the most commonly prescribed medication in the United States. Lisinopril is No. 2, as of 2014.
8. The most expensive drug is Glybera at a wholesale cost of $1.21 million per year. It is a gene therapy that helps restore lipoprotein lipase enzyme activity in those with familial lipoprotein lipase deficiency. Only 1 million patients have this extremely rare condition.
The Twelve Tables (aka Law of the Twelve Tables) was a set of laws inscribed on 12 bronze tablets created in ancient Rome in 451 and 450 BCE. They were the beginning of a new approach to laws where they would be passed by government and written down so that all citizens might be treated equally before them. Although not perhaps a fully codified system, it was a first step which would allow the protection of the rights of all citizens and permit wrongs to be redressed through precisely-worded written laws known to everybody. Consequently, the Roman approach to law would later become the model followed by many subsequent civilizations right up to the present day.
CREATION OF THE TWELVE TABLES
According to tradition, in 451 BCE a committee, the decemviri, were, following public pressure, given the task of composing a law code which would better represent the interests of the ordinary people (plebeians) and reduce the undue influence on Roman law of the aristocrats (patricians) and priests (pontifices). These latter had exclusively sat on a council which interpreted the law as they saw fit. In preparation for this responsibility, a delegation of three men was sent to Athens where they studied the laws of the celebrated lawgiver Solon (c. 640 – c. 560 BCE). Then ten men, all patricians, were given consular power (imperium) and permitted to draw up a list of laws which they considered most needed and useful.
That is the traditional view of events, although, perhaps more realistically, the composition of the Tables was an attempt by the elite to better govern themselves and prevent abuses within their own social group. In any case, the result was a list of written laws (legibus scribundis) presented on ten tables and two more were added the following year to bring the total to twelve. As a consequence, laws became statute, that is they were made only after first being decided on by a legislative body and were no longer based on mere custom and tradition.
THE LAWS OF THE TWELVE TABLES
The exact reason why the Tables were drawn up may have been lost in the mists of time but once written their content was consistently referenced in later Roman written works. Unfortunately, the tablets themselves have not survived, destroyed, according to tradition, when Rome was sacked by the Gauls in 390 BCE. From some remaining fragments and those references in literature, it is possible to identify at least some specifics.
THE TWELVE TABLES WAS A LIST OF LAWS COVERING MOST AREAS OF PRIVATE LAW & CONCENTRATING ON RELATIONS BETWEEN INDIVIDUAL CITIZENS.
The list of laws seems to have covered most areas of private law and concentrated on relations between individuals (as opposed to individuals vs. the state or the rights of non-citizens) and thus is more a list of civil actions and penalties than a full, all-encompassing law code. It also largely dealt with areas relevant to an agricultural state. For example, the crime of arson was punishable by the death penalty (poena capitis), in this case by burning. The crime of using magic on crops was also punishable by death, this time by a form of crucifixion. Lesser penalties for property damage were banishment from Rome, loss of citizenship, and, for being an accessory to a crime, confiscation of property. Settlements could also be made by paying compensation to the plaintiff and thus avoiding court.
Other areas covered were procedural such as the ius vocation which was a private summons. If a plaintiff communicated to the accused they wished to bring a case against them then the accused was obliged, and could even be physically forced, to appear before a magistrate. Family law was also a part of the Twelve Tables with rules regarding marriage, guardianship, inheritance, and funerals prevalent.
Problems of practical application were soon apparent when some patricians refused to submit to the statutes of the Twelve Tables. The ordinary people were also now startled to see, for the first time, many of the rules which had already been in place but not made quite so transparent until now. These factors led to an uprising by the plebeians in 449 BCE and the forced resignation of the decemviri. Rome’s constitution was revised, the institutions of tribunes and consuls were reinstated, and the Twelve Tables became the basis of Roman law. The actual bronze tablets were set up in the Forum of Rome for all citizens to see, and Cicero records that students studied them as a part of their education.
In addition to these early problems, some specific laws in the original tables were not very long-lasting such as that which prohibited intermarriage between patricians and plebeians. This law was cancelled in 445 BCE with the enactment of the lex Canuleia. Other laws within the Twelve Tables were modified over time and, from the 3rd century BCE, they were steadily replaced by laws more relevant to the evolving Roman society and the dramatic expansion of the Republic.
Although some scholars insist the Twelve Tables were not quite the ‘all equal before the law’ that tradition has claimed and that they were not enough alone to be defined as a complete law code, they, nevertheless, indisputably set the foundation for what would become a system of fully codified law in the Roman world. The decemviri must also be credited with creating laws which were of practical value, separated from any religious consideration, visible to all, and outlined in precise language with explicit definitions. Thus, the Romans created an approach to legal matters which would be copied by countless other societies and governments ever since.
The Justinian Code or Corpus Juris Civilis (Corpus of Civil Law) was a major reform of Byzantine law created by Emperor Justinian I (r. 527-565 CE) in 528-9 CE. Aiming to clarify and update the old Roman laws, eradicate inconsistencies and speed up legal processes, the collection of imperial edicts and expert opinions covered all manner of topics from punishments for specific crimes to marriage and the inheritance of property. Not only used as a basis for Byzantine law for over 900 years, the laws therein continue to influence many western legal systems to this day.
A NEW LAW CODE
In February 528 CE Justinian I assembled a group of ten legal experts and 39 scribes to reassess Byzantine law and compile a new collective legislative code. It was a truly Herculean task which involved studying hundreds of documents and Latin Roman laws dating back to the early Roman Republic of the west, deciding which were no longer relevant, which should be maintained, and which needed some adapting. The old system relied on such diverse traditional sources of Byzantine law as the Codex Gregorianus(imperial edicts from 196 to 284 CE), Codex Hermogenianus (mostly imperial edicts of Diocletian, r. 284-305 CE), and Codex Theodosianus (issued in 438 CE and containing edicts dating back to Constantine I, r. 306-337 CE).
FROM OVER 2000 BOOKS & THREE MILLION LINES OF LEGAL TEXT, A NEW COMPREHENSIVE & CONSISTENT BODY OF LAWS WAS PRODUCED.
Many of the laws within the older works were repetitive, contradictory or simply did not meet the requirements of a society which had since moved on from earlier Roman times. From over 2000 books and three million lines of legal text, a new comprehensive and consistent body of laws had to be thrashed out and distilled and then better organised into subjects and themes. As a result, Justinian would achieve his multiple aims of making the laws clearer for all, reducing the number of cases brought before the courts (many were based on misunderstandings and a misinterpretation of what actually was the law), and increasing the speed with which legal cases were dealt with. Justinian may also have been motivated by a desire to outdo the famed legal achievements of Theodosius II (r. 402-450 CE), and this he undoubtedly did achieve. Finally, a new and consistent law code would help in Justinian’s plan to expand the Byzantine Empire into new territories and bring those societies under the jurisdiction of Roman law.
The commission to update Byzantine law was led by the great legal expert Tribonian who had already served as quaestor of the Great Palace of Constantinople, the highest legal position in the empire. The first part of the Corpus Juris Civilis was completed in April 529 CE, and two more parts were added in the following year. The work superseded all previous legal documents and records of any kind. To add to these, Justinian himself issued decrees, and thus the Justinian Code was eventually made up of four main parts:
- Codex Justinianus - the Codex, issued in 529 CE, was a collection of 12 books containing 4,562 imperial edicts from the time of Hadrian (r. 117-138 CE) to Justinian I himself, organised by theme and all correctly attributed to the emperor who had made them and with a date. Interestingly, the first book deals with ecclesiastical topics whereas in the older codexes this was dealt with last - an indicator of how Christianity had become more entrenched in Byzantine culture by the 6th century CE.
- Digestum (or Pandectae) - the Digest (or Pandects), issued in December 533 CE, was a compendium of legal opinions by celebrated Roman jurists of the past, which could be cited by claimants and defenders in court. It was also designed to be of use to practising judges. These words of wisdom were all edited, reduced and assembled into 50 books (instead of the previous 1,500) and all organised by subject. The works of the prolific 2nd-3rd century CE lawyer and writer Ulpian (aka Domitius Ulpianus) were especially popular with Justinian’s legal team, and these make up 40% of the Digest.
- Institutiones - the Institutes, also issued in December 533 CE, was a sort of handbook of the Codex and Digestum for law students to better understand and apply them. It was compiled by Trebonian and two other experts, Theophilos and Dorotheos.
- Novellae Constitutiones - the Novels (or New Laws) was a collection of the imperial edicts made by Justinian between 534 and 565 CE, the final year of his reign. Instead of Latin, as used previously (and still used in the other three parts), Greek was mostly used in these new edicts, the common language of the Byzantine Empire.
The laws within this huge body of work (still around 1 million words) dealt with every aspect of life and society in Byzantium. There are matters regarding the constitution, the powers of the emperor, the duties of high-ranking officials, and the sources of law. There are matters of private law and criminal law with punishments listed for specific crimes, as well as coverage of administrative affairs and issues related to tax, local government, the civil service, and the military. As with previous Roman law, a particular concern was the relations between individuals such as contracts, marriage, divorce, property ownership, inheritance, and succession. Finally, ecclesiastical matters were given much greater prominence in a departure from previous law codes.
The Novels, in particular, addressed the social changes that Byzantine society had undergone and its evolution away from the Roman society of Constantine’s days. Thus the rights of such groups as women, slaves, and children were improved. Further, it was now established, for the first time in Roman law, that the emperor was the single legitimate source of law.
Justinian’s Code was itself revised within a few years to reflect recent legislation and reissued in December 534 CE (it is this version which exists today). To prevent any future confusion as to what was what, all commentaries on the Code were banned. The Code was studied by students of law in the fifth year of their studies. As a consequence, gradually most of the Codex was translated into Greek by the end of the 6th century CE. Justinian’s Code was also introduced into the recently reconquered Italy (in 554 CE), but it was relatively neglected there until the 11th century CE when it was incorporated into the medieval Corpus Iuris Civils using Latin instead of Greek. Parts of North Africa also used the Code until the Arab expansion of the 7th century CE.
ROMAN & THEN BYZANTINE LAWS WERE, ABOVE ALL, RATIONAL, PRECISE & COMPREHENSIVE.
The body of laws created by Justinian and his experts, in one form or another, lasted for almost a millennium until the fall of the Byzantine Empire in 1453 CE. New Byzantine laws were, of course, added to it over the centuries as each emperor issued their own edicts and society evolved. Leo VI (r. 886-912 CE), for example, famously produced another collection of Byzantine edicts and had everything translated into Greek as next to nobody understood Latin anymore (few ordinary people would have even in Justinian’s day).
The Corpus Juris Civilis may have failed in Justinian’s aim to aid his imperial ambitions but, as it became a fundamental element of any higher education across Europe from the 11th century CE and has become the basis for many legal systems ever since, perhaps he did, in the end, achieve something of a lasting cultural domination. The Code is a monument to rival his other great achievement, the Hagia Sophia of Constantinople. Roman and then Byzantine laws were, above all, rational, precise and comprehensive, and it is these qualities which have greatly influenced many of the national and international laws by which we live today. As the historian J. H. Rosser notes:
In ancient Greek medicine illness was initally regarded as a divine punishment and healing as, quite literally, a gift from the gods. However, by the 5th century BCE, there were attempts to identify the material causes for illnesses rather than spiritual ones and this led to a move away from superstition towards scientific enquiry, although, in reality, the two would never be wholly separated. Greek medical practitioners, then, began to take a greater interest in the body itself and to explore the connection between cause and effect, the relation of symptoms to the illness itself and the success or failure of various treatments.
GREEK VIEWS ON HEALTH
Greek medicine was not a uniform body of knowledge and practice but rather a diverse collection of methods and beliefs which depended on such general factors as geography and time period and more specific factors such as local traditions and a patient’s gender and social class. Nevertheless, common threads running through Greek medical thought included a preoccupation with the positive and negative effects of diet and a belief that the patient could actually do something about their complaint, in contrast to a more fatalistic and spiritual mindset of earlier times.
FOR THE ANCIENT GREEKS, THERE COULD BE BOTH A DIVINE & A PHYSICAL CAUSE OR REMEDY FOR ILLNESSES.
However, the distinction between the spiritual and physical worlds are often blurred in Greek medicine, for example, the god Asclepius was considered a dispenser of healing but also a highly skilled practical doctor. The god was called upon by patients at his various sanctuaries (notably Epidaurus) to give the patient advice through dreams which the site practitioners could then act upon. Grateful patients at the site often left monuments which reveal some of the problems that needed to be treated, they include blindness, worms, lameness, snakebites and aphasia. As Epidaurus illustrates, there could, then, be both a divine and a physical cause or remedy for illnesses.
Lifestyle and such factors as heat, cold and trauma were discovered to be important factors in people’s health and they could alleviate or worsen the symptoms of an illness or the illness itself. It was also recognised that a person’s physical constitution could also affect the severity of, or susceptibility to, an illness. There was also a growing belief that a better understanding of the causes of an illness’ symptoms could help in the fight against the illness itself. With a greater knowledge of the body there also came a belief that the balance of the various fluids (humours) within it could be a factor in causing illness. So too, the observation of symptoms and their variations became a preoccupation of the Greek doctor.
GREEK MEDICAL SOURCES
Textual sources on Greek medical practice begin with scenes from Homer’s Iliad where the wounded in the Trojan War are treated, for example, Patroclus cleaning Eurypylus’ wound with warm water. Medical matters and doctors are also frequently mentioned in other types of Greek literature such as comedy plays but the most detailed sources come from around 60 treatises often attributed to Hippocrates (5th to 4th century BCE), the most famous doctor of all. However, none of these medical treatises can be confidently ascribed to Hippocrates and next to nothing is known about him for certain.
The Hippocratic texts deal with all manner of medical topics but can be grouped into the main categories of diagnosis, biology, treatment and general advice for doctors. Another source is the fragmentary texts from the Greek natural philosophy corpus dating from the 6th to 5th century BCE. Philosophers in general, seeing the benefits of good health on the mind and soul, were frequently concerned either directly or indirectly with the human body and medicine. These thinkers include Plato (especially in Timaeus), Empedocles of Acragas, Philistion of Locri and Anaxagoras.
DOCTORS & PRACTITIONERS
As there were no professional qualifications for medical practitioners then anyone could set themselves up as a doctor and travel around looking for patients on whom to practise what was known as the tekhnē of medicine (or art, albeit a mysterious one). The Spartans did, though, have specific personnel responsible for medical care in their professional army. Also, practitioners do seem to have generally enjoyed a high regard despite the lack of a recognised professional body to supervise and train would-be doctors and the odd mad doctor that crops up in Greek Comedy. As Homer states in the Iliad (11.514), ‘a doctor is worth many other men’. Not only doctors gave medical advice and treatment but other groups who could utilise their practical experience such as midwives and gym trainers.
THE HIPPOCRATIC OATH WAS ACTUALLY A RELIGIOUS DOCUMENT ENSURING A DOCTOR OPERATED WITHIN & FOR COMMUNITY VALUES.
The famous Hippocratic Oath was probably reserved for a select group of doctors and it was actually a religious document ensuring a doctor operated within and for community values. With the Oath the practitioner swore by Apollo, Hygieia and Panacea to respect their teacher and not to administer poison, abuse patients in any way, use a knife or break the confidentiality between patient and doctor.
Famous medical practitioners included the 4th century BCE figures of Diocles of Carystus (who had a head bandage and spoon instrument for removing arrowheads named after him), Praxagoras of Cos (noted for his ‘discovery’ of the pulse and being the first to distinguish veins from arteries), and the Athenians Mnesitheus and Dieuches. These experts in their field could examine a patient’s face and make a diagnosis helped by information such as the patient’s diet, bowel movements, appetite and sleeping habits. Treatments often utilised natural plants such as herbs and roots but could also include the use of amulets and charms. Surgery was generally avoided as it was considered too risky but minor operations may have been carried out, especially on soldiers wounded in battle.
MEDICAL TREATMENTS: WAR
Wounded soldiers were actually one of the best ways for a doctor to learn his trade and widen his knowledge of the human body and its internal workings. There was probably also less risk of the soldier causing problems if things went wrong, which could happen with private patients. Aside from the health problems which may also have affected civilians such as malnutrition, dehydration, hypothermia, fever and typhoid, those doctors treating soldiers had to deal with wounds made by swords, spears, javelins, arrows and projectiles from slings. Medical practitioners knew the importance of removing foreign bodies such as arrowheads from the wound and the necessity to properly clean the wound (which is why arrowheads became barbed to be more difficult to remove and therefore more lethal). Greek doctors knew that it was important to stop excessive blood loss as soon as possible in order to prevent haemorrhage (although they also thought blood-letting could be beneficial too). Surgery may also have included the use of opium as an anaesthetic, although the many references in literature to patients being held down during surgery would suggest that the use of anaesthetic was rare.
Post-operation, wounds were closed using stitches of flax or linen thread and the wound dressed with linen bandages or sponges, sometimes soaked in water, wine, oil or vinegar. Leaves could also be used for the same purpose and wounds may also have been sealed using egg-white or honey. Post-operation treatment was also considered - the importance of diet, for example, or the use of plants with anti-inflammatory properties such as celery.
DISCOVERIES & DEVELOPMENTS
Over time doctors came to acquire a basic knowledge of human anatomy, assisted, no doubt, by the observation of grievously wounded soldiers and, from the 4th century BCE, animal dissection. However, some claimed this was useless as they believed the inner body changed on contact with air and light and still others, as today, protested that using animals for such purposes was cruel. Human dissection would have to wait until Hellenistic times when such discoveries as the full nervous system were discovered. Nevertheless, there was an increasing urge to discover what made a healthy body function well rather than what had made an unhealthy one break down. The lack of practical knowledge, though, did result in some fundamental errors such as Aristotle’s belief that the heart and not the brain controlled the body and the idea proposed in the treatise On Ancient Medicine (5th century BCE) that physical pain arises from the body’s inability to assimilate certain foods.
Greek medical practice may have included errors, perhaps many and probably even fatal ones, but Greek practitioners had started the medical profession in the right direction. Observation, experience and experimentation meant that those who followed in Hellenistic and Roman times such as Galen and Celsus could continue their enquiries along the long road towards greater and more accurate scientific knowledge of the human body, the illnesses it is susceptible to, and the potential cures available.