The History of pharmacy is the history of compounding. Compounding occurs when a pharmacist prepares a medication by combining, mixing, or altering two or more ingredients for a patient based on the receipt of a valid prescription. For compounding to occur a valid relationship must exist between the pharmacist-physician-patient. This is known as the compounding triad.

Compounding dates back to biblical times. Ointments, balms, perfumes and oils are examples of compounding often referred to in the bible. The process of compounding was used to prepare these biblical preparations. In the Catholic bible the book of Sirach, referring to plants states By them the physician heals and takes away pain; the pharmacist makes a mixture from them. Compounding was used extensively in ancient times. Plants were the main ingredients in pharmaceutical mixtures even in modern times. A compounding pharmacist would take the medicinal plants and make concoctions, decoctions and extracts.

Compounding is also referred to in the story of the birth of Jesus. One of the wise men brought the gift of aromatic myrrh to the baby Jesus as a gift made by a compounding pharmacist. Myrrh is still is used today in compounding, often to treat inflammation and ulceration of the mouth and throat and pharynx and in spongy and bleeding gums. Internally, myrrh has been used in chronic cough, catarrh, and as an expectorant.

There existed a close relationship between compounding and religion up until the end of the period of alchemy during the medieval times. The birth of modern chemistry and pharmacy occurred when philosophy gave rise to the scientific method. The use of science to separate fact from myth caused a rapid expansion of the numbers of plants used for medicinal purposes.

One of the most interesting developments in the history of compounding occurred with the use of coal tar for medicinal purposes. Coal tar contains hundreds of various chemicals. When applied topically coal tar often cures or treats many skin conditions like dandruff. German chemists began to isolate the different constituents of coal tar and developed synthetic dyes from them. One of these synthetic dyes was the first sulfa drug which gave rise to modern antibiotic therapy.

Compounding pharmacists used their intuition and scientific method to develop various medications. Petroleum jelly was discovered to contain healing properties. Fly larva was discovered to produce a substance, allantoin, which rejuvenated damaged skin. Quinine alkaloids from the bark of the South American Cinchona tree was discovered to treat malaria and leg cramps. Witch hazel, digitalis and opium are other examples of the plants and natural substances compounding pharmacists used to prepare medications for their patients.

As time went on, some chemists specialized exclusively in the compounding of medications. Thus the term "chemist" is still used to refer to a pharmacist in England. These chemists became known as pharmacists or druggists in the United States. By the 1800’s compounding became the exclusive domain of the specialized chemist. Compounding was needed because most of the medications required preparation to be usable. It was the practice of compounding that developed laudanum, one of the first pain medications. Laudanum is a combination of opium extract in the extraction vehicle, alcohol.

By the 1800’s most towns and cities in the United States had a drugstore staffed by a compounding pharmacist. Education requirements were established and societies of apothecaries began. One group of compounding professionals started the National Formulary and another started the United States Pharmacopoeia in 1820.

In 1877, compounding pharmacist, Dr. Squib, the drug company founder reinvigorated the United States Pharmacopoeia. Eventually the National Formulary and the United States Pharmacopoeia combined their efforts and set medicinal standards for the American public. Other noteworthy compounding publications were The Dispensatory of the United States of America, Remingtons and Martindales. All of these books contained information about the proper compounding practices as well as formulation standards.

As compounding continued to grow, compounding pharmacists needed to develop good tasting vehicles to dispense bad tasting drugs to their patients. These innovative compounding pharmacists developed various syrup extracts for this purpose. Compounding pharmacists learned that soda water when combined with syrup made drugs even more palatable. It was soon discovered that these syrups and soda water tasted great when combined so the soda fountain was born.

Charles Hires was a Philadelphia compounding pharmacist who according to his biography discovered a recipe for a delicious herbal tea while on his honeymoon. These compounders marketed sodas like Coke and Pepsi and thus the great soft drink industry was started. In May, 1886, Coca Cola was invented by John Pemberton a compounding pharmacist from Atlanta, Georgia. The term soft drink was not always applicable to these sodas. Sodas like Coke contained caffeine from the Kava plant and cocaine from the cocoa leaf. Coke-Cola took off when it was marketed as a headache remedy. It really did work but the risk of addiction outweighed the benefit.

Compounding pharmacists started the pharmaceutical industry with well-known companies like Eli Lilly, Merck, Squib, Upjohn and Sandoz to name a few. Merck eventually sold pure compounding chemicals to compounding pharmacists.

Allopathic Medicine the branch of medicine practiced by medical doctors owes the basis of their medical practice in large part upon compounding. The allopathic school uses drugs extensively to treat and cure diseases. This would have been impossible without compounding pharmacists to develop and make the drugs they prescribe. Other medical practitioners such as osteopathic doctors, naturopaths and homeopathic doctors all have the compounding pharmacist to thank for the success of their branches of medicine.

During the industrial revolution major drug manufacturing came into existence. Based upon compounding principles these compounding pharmacists increased their production capacity and began mass-producing medications. The mass produced drugs were enticing to compounding pharmacists because they made their life easier. No longer would a compounding pharmacist have to toil to prepare a compound while their patient waited. The compounding pharmacist could simply count out some manufactured pills and dispense them. This began the demise of the compounding pharmacist.

During the early 1900’s just about every prescription dispensed was compounded. By the 1960’s compounding was less than 5 percent of all prescriptions dispensed. The compounding pharmacist became a dispenser of medications rather than a compounder. In the 1950’s pharmacists were still trained extensively in compounding. Classes on compounding were an essential part of the pharmacy education. By the 1980’s compounding classes had become relegated to basically an after thought by most colleges of pharmacy.

During this time some pharmacists looked at each other and wondered what had happened to their profession. With good intentions and profit motive the government and major drug companies had slowly eroded the practice of compounding. Some of these pharmacists began the journey back to their compounding roots.

Today compounding has become a normal part of the pharmacy profession again thanks to the efforts of pharmacists in the 1980’s. Additionally bulk drug distributors like PCCA, Medisca, Hawkins Chemical, Apothecary Products and Paddock all have substantially contributed to compounding. The International Journal of Pharmaceutical Compounding (IJPC) is a scientific journal emphasizing quality pharmaceutical compounding.

Compounding continues to expand and plays an important role in the healthcare of millions of people. Compounding pharmacists have developed many innovative new compounds. Many disease states have been cured or effectively treated thanks to compounding.
 

Dr. Tara A. Solomon,  FACOG

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