The Development in Italy

Pharmacys development received early stimulus from the heavy Mediterranean trade in drugs that
funneled through Italian ports and from frequent contacts with Islamic concepts of ordering society,
including pharmaceutical services.
Italy is the classic soil of European pharmacy as it is that of most of European professions and arts. The
law of the German ruler of the Two Sicilies, Frederick II (see pages 35 and 467), although promulgated in
Italy and for Italian territory, was born more out of the German spirit. The first real Italian legal
regulation of the duties of both physicians and apothecaries known are the Venetian statuta
promulgated in 1258. Although they resemble the edict of Frederick II, the statuta mention neither a
limiting of the number of pharmacies nor governmentally fixed prices for remedies. The statutes
forbade the practice of medicine by the pharmacist, and specifically stated that he was not allowed to
examine the urine of patients, which up to the 17
th
century was one of the most important means of
medical diagnosis. Official supervision of the drug trade, wholesalers as well as retailers (the latter called
speziarii and aromatarii), had existed in Venice as early as the 12
th
century.
ORGANIZATION INTO GUILDS
Italian pharmacies were not created by governmental edict but existed long before legislation dealt with
them. Consequently, they had found their natural place within the framework of the guild systeman
organization that had a special dignity and task, particularly in Italy.
We know of guildlike associations already in ancient Rome, where somewhat shadowy predecessors of
the pharmacists, the seplasiarii (see page 23 and 485), are said to have been united in such a guild. They
were founded mainly for a social and welfare purposes, and the regulating of conditions of trade. In
wartime they could be mobilized for military purposes.
The organization of merchants and craftsmen into guilds, according to the kind of goods sold or
manufactured, is one of the most significant features of the Middle Ages. During the period of feudalism
the guild system created a bourgeoisie regulating both production and distribution. However, there
were great differences in the manner in which the guilds in the several countries fulfilled their task. In
France, England and Germany the guilds were restricted largely to the internal organization, regulation
or administration of their special occupation. In Italy, much more than elsewhere, they were also
political, important cogs in the governmental machinery of the city republics up to the 17
th
century.
In Florence, physicians and pharmacists combined in the same guild, together with some others, toward
the close of the 12
th
century. When, in 1236, the principal trade corporations of Florence were divided
into two division, i.e., the seven major arts and the fourteen major arts, the distinction was one both of
technic and of class. As group six, the guild of physicians and pharmacists belonged to the major arts,
the arts of higher esteem.
In the membership lists of the various guilds (1297-1444) about 70 different callings were represented.
Among these the pharmacists and the wholesalers of drugs outnumbered all the others. That is
understood readily if we recall that at this time Italy (more particularly Florence, Genoa and Venice)
governed the entire European trade in oriental drugs and spices. Guild statutes (1349) mention no less
than 206 different articles as belonging to the monopoly of the pharmacists or spicers. Their trade
extended to many products that at this time were rare and costly, such as book manuscripts and wax
candles. Even funerals, especially those of the wealthier citizens, were conducted by the pharmacists.
Supervision was rigid. Once a year the pharmacies were confiscated and the culprits excluded from
professional practice for variable periods.
The part played by the guild of physicians and pharmacists in Florence was characterized by Staley: a
great guild it truly was it yielded to none in the loftiness of its aim and in the splendor of its
achievements.
In various other Italian cities, guilds of pharmacistseither separate or together with physiciansfirst
appear in records of the 13
th
and subsequent centuries.
The oldest Italian pharmaceutical guild still existing is the Noblle collegio chimico farmaceutico founded
in time immemorial and solemnly renewed in 1429 by a special edict of Pope Martin V. The tasks of the
guild were (1) the care of poor and sick members, (2) the immatriculation and location of all
pharmacists who have passed the examinations, (3) the regulation of the distance between pharmacies,
(4) the regulation of the prices for remedies, (5) the collection of taxes, to be delivered to the
government and (6) the supervision of the producers and the retailers of food, liquors, pastries and
medicinal herbs. These tasks can be regarded as traditional for the Italian pharmaceutical guilds.
Of course, pharmaceutical conditions were not uniform in the different states established on Italian soil
between the 13
th
and 19
th
centuries. Thus, there were variations in the important provision for
separating the medical and the pharmaceutical professions. While all commercial association between
the professions was forbidden (although not always rigidly enforced) in Southern Italy, Rome, Pisa and
many other Italian states, the Florentine statute (1313) allowed the pharmacist to employ a pharmacist.
A similar regulation appears in the Mantuan statute of 1303. In Pistoia, and later in Florence, similar
arrangements permitted physicians and pharmacists to share in the ownership and income of a
pharmacy. The pharmacist was forbidden to reimburse the physician for individual prescriptions,
however.
In most Italian towns it was customary for the physician to see his patient in a pharmacy, or at least to
be available through the pharmacy.
Until the close of the 16
th
century the cultural influence of the powerful city-states made their
institutions a model for other parts of Italy. From the 12
th
to the 16
th
centuries Italy was once more the
cultural center of the world. Pharmacists of Northern Europe, as well as physicians who desired a better
education than they could acquire at home, came to the renowned Italian universities (Padua, Bologna,
Pisa and Ferrara). This cultural development rested on the wealth acquired by the city-states. Their
merchant princes, such as the Medici of Florence, not only controlled the oriental spice trade but were
international bankers as well. The Italian trade, including drugs, extended form Constantinople,
Damascus, Alexandria and Tunis to southern Germany, France, London, Lisbon, Antwerp and Bruegge in
the north.
EARLY LARGE-SCALE MANUFACTURING
The Italian drug trade was supplemented very early by the development of a chemical industry, the first
on Europe soil. In 1294, Venice was producing corrosive sublimate and cinnabar and, somewhat later,
sugar of lead, borax, soap, sal ammoniac, Venetian tak and Venetian turpentine. A very important
pharmaceutical export was Venetian treacle (from Latin, theriaca, an antidote, q.v. p. 489). Another was
the famous Venetian troches of vipers, legally required in some European states for the local
preparation of treacle.
In Italy we also observe for the first time industrial pharmaceutical activity by the monasteries. Thus the
monastery of the church of Santa Maria Novella in Florence was famous for distilled waters and
cosmetics that the monks prepared and sold.
STATUS IN SOCIETY
The important role played by Italian pharmacy and pharmacists in the political and social life of the
country found one expression in public esteem as well as in the equipment of the pharmacies. The
Italian pharmacist was always considered a patrician. In Venice the profession was officially recognized
as an arte nobule; and pharmacists were granted the right to marry Venetian ladies of noble rank.
During the middle of the 14
th
century, the Florentine pharmacist Matteo Palmieri was ambassador of his
country to the court of the King of Naples. Up to the present there has always been a number of
pharmacies active in Italian politics and represented in the literature of their country. Even in the
military service the social and professional recognition of the calling found early expression, putting the
pharmacist on an equal level with the physician. This has been true from the establishment of the
modern Italian kingdom up to our time.
The Italian pharmacies of the Renaissance expressed status by rooms of architectural beauty, with
equipment that today is highly valued by connoisseurs of Italian art and is the pride of many museums
and private collections. The development of pottery from a simple handicraft to an art was especially
stimulated by Italian pharmacy. Private pharmacists, hospitals and the high nobility competed with each
other in adoming their shops or pharmaceutical workrooms and storerooms with precious faience jars
and jugs to hold precious medicaments.
FROM GUILD TO GOVERNMENT RULE
Italian trade and wealth declined after the discovery of America and particularly of the all-water route to
the East Indies. As early as 1501, King Manuel of Portugal wrote to the Venetian government that there
was no longer a reason for Venetian merchants to send ships to Egypt (and the Levant), suggesting that
they should rather buy their oriental goods in Portugal. The time of the Italian intermediate trade was a
thing of the past. The drugs of the Orient were brought directly to Europe by the Portuguese and, later,
by the Dutch; the drugs of the New World were made available first by the Spaniards and then by the
English. In the unhappy Italian situation of the 17
th
century, Venice and Genoa were on the road to
decadence, Lombardy was pillaged by the Spanish, French and Germans, the small Italian states were
tormented by the lights of princes.
The political importance of the guilds declined with the declining wealth and political power of the
Italian municipalities. However, under government authority they retained a certain internal authority
within their own occupational fields.
Conditions changed in the 18
th
century, which was characterized politically by interference on the part
of Austria, the rise of Savoy in the North, and the re-establishment of the southern Italian kingdom as
the Kingdom of Naples. It was Austrian regulations for Lombardy (1778) that gave the impulse for
progressive pharmaceutical legislation in Italy as a whole. One of the most important innovations was
the limitation of the number of pharmacies, allowing one pharmacy to 5,000 inhabitants in the Northern
Italian territory then under Austrian rule. However, the organization of pharmacy in the various Italian
states existing before 1870 differed greatly. In some of them the number of pharmacies was not limited;
in others one pharmacy was allowed to 3,000 inhabitants, as in Rome, or a certain distance was required
between the pharmacies, as in Naples.
The new Italian Kingdom established in 1870 gradually reduced these variations to a uniform system.
From 1888 registered pharmacists were authorized to practice their profession anywhere in Italy, and
were allowed the unrestricted opening of pharmacies. Unfortunately, the new pharmacies opened
under this law were for the most part in the large cities. Severe competition destructive of standards
developed in the metropolitan districts; while in the country the need for well distributed pharmacies
was not met.
The unrestricted and uncontrolled establishment of new pharmacies thus proved of no advantage either
to pharmacy itself or to the public. Therefore in 1913, a new set of restrictions replaced the freedom of
the law of 1888, after long controversy.
With the new enactment, regional differences in pharmaceutical requirementsvestiges of the varied
states and principalities of earlier centuriesfinally disappeared. Everywhere, the opening of a
pharmacy henceforth was considered a privilege to be earned through a government administered
competition. The number and distribution of pharmacies became government-controlled: 1 pharmacy
per 5000 citizens, and, in the cities, at least 550 yards apart. If one eventually became a pharmacy
owner it was a lifetime privilege.
The old permanent privileges, granted by rulers or by municipalities, were supposed to be closed out
within a 30-year grace period. If not sold by then, a government competition would be held to pass the
pharmacy into new hands (although exceptions later proved to be a political necessity). In rural areas
where the practice of pharmacy was less attractive and less prosperous, subsidies were provided to
induce better geographic distribution of pharmacistsa method traditional in Sweden and some other
countries. The dispensing of all medication packaged as separate doses was reserved to pharmacists. For
prescription medications on an official list, prices were government-controlled. A system of inspection
and control of pharmaceutical services in Italy was funded by license fees.
Social change beginning in the 1950s, especially an upsurge in the number of young pharmacy
graduates flooding from the universities, compelled the government to consider relaxing the restriction
on the number of pharmacies authorized and other reforms. The question was complicated by the
reluctance of old pharmacists to give up their pharmacies and retire, especially with the continuing
devaluation of Italian currency. This movement culminated in a revised pharmacy law adopted by the
Italian parliament in 1968, which brought notable changes.
Pharmacies in Italy henceforth could be bought and sold freely among pharmacists but subject to certain
limitations (e.g., minimum five-year interval, to minimize speculation). New pharmacies, however, still
could be opened by private pharmacists only by government permit awarded through competitive
examination. The closing of municipally-owned pharmacies, foreseen already in the 1913 law, has not
materialized. Indeed, under current law municipalities and civil hospitals could preempt up to half the
permits.
While control of the number of pharmacies has been continued, the 1968 law dropped the ration from
5000 to 4000 persons per pharmacy (in cities over 25000), and the minimum distance between them
dropped (from 550) to about 211 yards. The traditional social rationale for assuring that a pharmacy will
have a reasonable number of clients is that it compensates for the government ceiling placed upon the
pharmacists fees, as well as helping to maintain the professional viability of a pharmacists
establishment. To try to deal with the problem of equitable distribution of medical care, pharmacists
who practice in a rural community of less than 5000 population are given preference when permits are
granted for opening new pharmacies in larger towns. It remains to be seen whether this provision will
entice enough young pharmacists to practice for a time in areas needing more accessible
pharmaceutical service. As in various other countries, ownership of private pharmacies is limited to
pharmacists (or, in the case of a corporation, pharmacists must own control). Pharmacists are aided by a
technician-class of assistants.
A pharmaceutical organization, the Federazione Ordini del Farmacisti Italiani, with headquarters in
Rome, works in close contact with the governmental authorities. There is an Ordini dei Farmacisti in
every province, as a branch of the government and under the authority of the provincial governmental
administration. Membership is compulsory for pharmacists, since authority has been delegated to the
Ordini to register pharmacists and to discipline those who overstep legal or ethical bounds (similar, for
example, to the Pharmaceutical Society of Great Britain).
How one prepared for the practice of pharmacy during the earlier period of organized pharmacy in Italy
may be exemplified by the Venetian statutes (1565). A student had to serve 5 years as an apprentice and
another 3 years as a clerk; finally, he was required to pass a rather rigid examination, after which he
became a pharmacist fully qualified to operate a pharmacy of his own. Such requirements were more or
less general for a long period.
The Austrian legislation of 1778, abovementioned, regulating pharmacy in Northern Italy (Lombardy),
made academic study and examination a requirement for pharmacists in this area. This requirement was
extended in 1805 to the Napoleonic Kingdom of Italy during its short life. Pharmaceutical education
thus, gradually, was transferred from the craft-like schooling by the guilds to the Italian universities.
Here as elsewhere, the trend toward science-based higher education was never reversed by later
political events.
Traditional, admission to a university course in pharmacy was limited to those holding a secondary-
school diploma from a Lyceum, a selective program preparatory to university-based careers. Under
democratizing pressures common to higher education in various parts of Europe, Italian universities
threw open their doors in 1970 to all students with diplomas from any type of higher secondary school,
or commercial institute). The entering student is ordinarily 19 or 20 years old, since Italian secondary
schools require somewhat longer and higher education than those in the United States.
The 4-year professional course, standard for some decades, continues as preparation for practice in a
pharmacy. Since 1967, however, most pharmacy faculties of Italy have introduced a second pharmacy
curriculum of 5 years, as preparation for students intending to enter a manufacturing laboratory,
toxicologic work, or a pharmacy. The basic structure of both curricula is a foundation of general scientific
studies followed by specialized pharmaceutical education.
Another change during this period cut the practical- experience requirement in half. Instead of a 1-year
probationary period in a pharmacy after university studies, the neophyte now receives 6 months of
controlled experience before becoming fully qualified as a pharmacist (permissible during the 4-year
curriculum, but in the 5-year curriculum permissible only after the academic studies).
Unlike in some European countries, in Italy the university diploma alone does entitle one to the practice
of pharmacy. Qualification is by a postgraduate board examination, somewhat analogues to American
custom, but with noteworthy differences. The examining board, consisting of university professors as
well as practitioners of pharmacy, sets both oral and practical examinations. A successful candidate may
practice as an employed pharmacist. To have the full responsibility of owning and operating a pharmacy,
a pharmacistafter at least five years of practicemay take a further competitive examination (as
previously mentioned).
After the close of the 17
th
century the Italian pharmacists as a class no longer contributed importantly to
the advancement of the pharmaceutical sciences. This was in spite of the high standards for the practice
of pharmacy and the social rank of the pharmaceutical practitioner. Whereas in France and Germany a
constellation of pharmacists went on to attain high standing as scientists and, therefore, recognition for
their profession, the attainments of Italian pharmacists rarely went beyond the compilation of treatises
for the practice of their calling. A possible explanation may be that, throughout the triumphant
development of chemistry from the latter part of the 18
th
through the 19
th
century, progress came
largely from researches conducted in France, Germany, England and Sweden. The great scientific
achievements of the Italians lay rather in the spheres of physics and medicine.
Early Medicinal Botany
Italian pharmacists and their apprentices utilized botanic gardens or maintained their own, for their
learning in botanic science was one hallmark of their calling and its ascendant repute.
By the 14
th
century, plots of medicinal herbs, therefore notable as an adjunct of monasteries, had
appeared as part of private gardens. One of the earliest known belonged to the famous author
Matthaeus Sylvaticus at Salerno, who wrote a dictionary of simple drugs and their uses (Pandectae... ca,
1317). Similar gardens flourished about this time at Castelnuova and Naples. In 1545 the famous botanic
garden at Padua was established, which might be called the first in a modern sense.
The first chair at a European university for pharmacognosy (lettura dei semplici) was in Padua (1533),
and others soon followed. The well known botanist Ghini taught there. One of his students published
(1544) a famous commentary on Dioscorides that continued in use through numerous editions and
translations as the encyclopedia of herbal material medica of the Renaissance.
DEVELOPMENT OF A LITERATURE
The early pharmaco-botanical gardens and cabinets of material-medica specimens were supportive of
early pharmaceutical education, whether through guild or university. Equally importantcertainly more
significant for the development of European pharmacy at largewas the pharmaceutical literature
generated in Italy during the Middle Ages and the Renaissance.
At first, the authors of pharmaceutical interest came from the ranks of medicine, as was the case in
other countries of the Western world. One of the earliest guides to the practice of pharmacy printed in
Europe was written in the middle of the 15
th
century by the physician Saladin di Ascoli. This book tells
the neophyte pharmacist how to collect, prepare and preserve drugs properly. It explains the terms then
used in pharmacy and material medica. It even describes the behavior appropriate to a proper
pharmacist, in the authors view. Perhaps it does not go too far to say that Saladins book was the first
real treatise on pharmacy and for centuries was the indispensable vade mecum (i.e., reference manual)
of the apothecary.
It was a harbinger of the growing independence and stature of a separate occupation of pharmacy when
Italian pharmacists began to generate their own pharmaceutical treatises. Especially noteworthy is The
Greater Luminary (Luminare majus), written by the pharmacist Joannes J. Manlius de Bosco toward the
end of the 15
th
century (published 1494), which became an authoritative guide for pharmacists in
several countries and cities. Another practicing pharmacist, Paulus Suardus, followed with a widely used
text called The Treasure chest of the Pharmacists (Thesaurus aromatariorum, 1512).
The tradition of such professional manuals reached one culmination in the 17
th
century with a real
pharmaceutical encyclopedia, which in some ways foreshadows the later universal pharmacopeias.
Written by the owner of the esteemed Ostrich Pharmacy in Venice, pharmacist Antonio de Sgobbis da
Montagnana, it contains comprehensive directions for the management of a pharmacy and describes
and illustrates all the pharmaceutical processes and apparatus (Nuovo el universal theatro farmaceutico,
1662; frontispiece no longer attained much renown beyond the borders of Italy.
The genesis of a special class of literature to unify the specifications for drugs lies partly in Italy. A
renowned early attempt was made by the Florentine guild of physicians and pharmacists, when it issued
a pharmaceutical formulary in 1499 (titled Nuovo receptario). In the preface, the physicians observed
that, the ill in our city are exposed to many dangers: for our pharmacists, whether in the city or
environs, have committed many errors because of the various ways of preparation, choice, care, and
manufacture of the simple and compound drugs necessary*So+ apothecaries should follow this *New
Formulary] not only will the apothecaries carry out their work without error but the physicians also may
be able to perfect their practice without any fear and for that achieve, with the help of God, praise and
great reward.
Since the guild intended this book to be obligatory for pharmacists, it often has been considered the first
European pharmacopeia. The lack of evidence of a legal enforcement of these standards (which the
modern usage of the term pharmacopeia implies) leaves the status of the Nuovo Receptario in doubt.
Other Italian city-states, after a few decades, followed by the lead of Florence by issuing their own drug
standards (beginning with Mantua in 1559). In the pages these early local pharmacopeias one sees
reflected the nationalistic tendencies and the character of pharmacy as it had developed in the various
political units. The long struggle to unify the Italian peninsula as a single country came to fruition in
1870; but the standards for drugs were not unified for the entire country until 1892 when the first
edition appeared of the Farmacopoea ufficiale del regno dItalia.
A periodical literature of pharmacy began at the end of the 18
th
century with reports in Italian journals
of physics and of chemistry, and then was given primary attention for the first time in Italy with the
founding (1824) of the Giornale di farmacia, chimica e scienze affini. The 20
th
century has brought many
specialized pharmaceutical journals, but one particularly representative of the practicing pharmacist is
the official organ of the Italian Pharmacists Association. II Farmacista (f. 1947)