Federation International Pharmacy

SYDNEY CONGRESS 2003
Pha Col R.VAN DAMME
The history of military pharmacy – a survey

Before going deeper into the real subject which is the history of military pharmacy – I would like to give you some relevant data in the history of pharmacy in general

In medieval Western Europe there was mainly the monastery pharmacy, always with a mostly large herbal garden. From those times a lot of frescos and paintings, often movingly naïve and charming are known with as subject “The Christ as pharmacist”.
The fist European University where pharmacy was taught as a science was the University of Montpellier. But the very first regulation has been established under the reign of Emperor Frederic von Hohenstaufen.

In 1231 he edited an ordinance, the so-called “Constitutiones” which divided medicine in three branches:

• the dogmatic medicine, fixing diagnoses

• the manual medicine, in fact surgery, and

• pharmacy

Combining or collusion between the three branches was forbidden, and the Holy Roman Empire provided in separate inspectors for the three branches
The number and location of pharmacies has been regulated as well. From that moment on pharmacy became professional.

In the 13th Century pharmacists were called apothecaries or apothicarius, in French apothicaire or apoticare. They had a high social status, albeit a bit less than physicians. In the 15the Century the Dutch and German word apotheker or apteeker showed up. In French the name pharmacien would replace apothycaire only in the 19th Century.
The usual way to address to a pharmacist was the title of Master or Magister (which is by the way still the official title in Austria, in the military as well.

In the 17th century the strict separation of medicine and pharmacy has been stated (again) in ordinances and laws, and the larger part of legislation started up.
As to the history of military pharmacy, we will restrain ourselves to Spain, France, the German countries and the Netherlands and Belgium.

Back to Spain. Under Carlos I documents mention physicians, surgeons and pharmacists or "farmacéuticos"; but the most common term was "bóticos"
In 1567, during the reign of Felipe II we note the invention of the concept "military hospital", a permanent fixed facility meant to treat military and often the members of their families as well. The very first military hospital, although the Byzantine Empire knew military hospices . 

This fist military hospital was in Mechelen (Malines) nowadays in Flemish Belgium. 

From that époque documents came to us such as the "Ordenanzas para el régimen y gobierno de la Real Botica" containing the oldest known regulations for military pharmacy. 

Some tractates speak even about tropical pharmacy.
In 1647, under Felipe IV, the Real Botica of Farmacia Real has been erected – a kind of mobile pharmacy for the campaigns. The number of fixed military hospitals grew as well. Afterwards, in 1669, a tropical field pharmacy set would be created.

Toward the end of the century the fist pharmaceutical laboratories were organised. In these Laboratorios Yatro-Quimicos galenics and pharmaceutical chemistry were studied. It was as well the beginning of a military runned medicaments production in the Spanish Army.
In 1720 the first Boticario Mayor de los Reales Ejercitos has been appointed, the military pharmaceutical inspector for the field hospitals.

Pharmacy of Ceuta

Let us mention as well the fact that most pharmacies in the military hospitals were extremely luxurious In the Spanish Museum of Military Pharmacy, the officina of the Hospital Real de Ceuta has been reproduced.
Towards the end of the 18th Century military pharmacy became a university degree. The special status was emphasised by a particular uniform since 1796

I will not bother you with the vast organisation of the Corps in that time, but it is clear that military pharmacy was considered as very important. In 1831 elaborated guidelines or regulations saw the light.

However, around 1850, during the reign of Isabelle II the medical services were reorganised and the Pharmaceutical Corps lost quite some privileges to the physicians. It came to a legal court case lost by the pharmacists; with as result that Military Pharmacy was shut out of the University. On the other hand, this did not prevent the building of a large oversees network and the development of a mobile pharmacy.

And after a while no less than three inspectors were reassigned.  During the ephemeral reign of king Amadeo and the 1st republic (1868-1874) a general Pharmaceutical Inspector has been appointed and the Military Central Pharmacy got the right to deliver as well to family members of the military and to a range of public services.

Under Alfonso XIII, in 1927, again several very enlarged pharmaceutical commandments were created.
The 2e Republic (1931-1936) abolished the title of Inspector, but maintained the Pharmaceutical Chiefs in the Military Forces. It would lead us too far to explain the entire different pharmaceutical organisation both in republican and in nationalist camps during the Spanish Civil war. But since the monarchist fraction of General Franco won, their system was maintained, which meant a reinforcement of the Pharmaceutical Corps, and the creation of an Academia de Farmacia Militar.

Farmacia Central Madrid

The history of the pharmaceutical service of the Armada (the Spanish Navy) is quite recent and starts in 1895. Previously army pharmacists were sometimes affected to the Armada for a limited time, mainly in the preparation of expeditions, that means the composition of kits or “"caxas de medicinas".

It is worth mentioning as well that the Armada pharmacists were very active aboard and ashore in food control and the study of strange substances in the colonies.

The medical corpses of the Armada were joint during the 2nd republic in 1931, and the number of Navy pharmacists was reduced to 4 and even to nought afterwards, until their recreation in 1943 under the Caudillo Franco. .

About the Air Force we can be brief, since the corps was only founded in 1939, directly after the ending of the Civil war. They got their own Military Central Pharmacy in Burgos, the old nationalist capital during the Civil war. In 1947 an own Academy and School were erected for air force pharmacists and assistants. Until in 1990 the unification of all medical services has been achieved.

France, 1552. During the reign of Henry II de Navarre, for the fist time French military pharmacists are mentioned in the tractate "L'Etat des dépenses à entreprendre" (The state of expenses to undertake), written in the preparation of a field campaign. The text speaks about the "apothycaire du Roy", his portable pharmaceutical stocks for field use, and his salary of 20 pounds.

The 17th of January 1708 a royal edict creates a permanent Medical Service with his Officers Corps, which scrupulously enumerates the duties, the missions and the rights of physicians, surgeons and apothecaries. Just to name one: every military hospital pharmacist had the obligation to install " un jardin de plantes médicinales afin que l'apothycaire puisse trouver les herbes récentes desquelles on a ordinairement affaire à des sucs et y eslever encore plusieurs plantes rares et estrangères et y choisir un endroit exposé au soleil ...pour tout ce que les médecins ordonnent..."

In a free translation: “to install a medicinal garden, permitting the pharmacist to find the proper fresh herbs where normally only extracts are available, as well as rare and strange plants and choose a place exposed to the sun for everything which the doctors prescribe….”

In 1747 the first printed formularies has been edited, written by a surgeon and the pharmacist Geoffroy, entitled "Formules de pharmacie pour les hôpitaux militaires du Roy". – Pharmaceutical formulas for the Royal Military Hospitals”
From that moment on until nowadays, military pharmacist would be involved in the minute elaboration of formularies specially designed for the Armed Forces.

Military hospital pharmacies were often very sumptuous, with brilliant collections of China – faience – called “"La Montre de l'Apothicaire", to be freely translated in “the Pharmacist’s demonstration”
It has to be admitted that around 1790 the physicians were the master corps over the surgeons and the pharmacists. Apothecaries collected and cultivated plants, accompanied the physician during his rounds, had to witness the administration to the patients, and had to create reserves.
In 1761 Cadet de Gassicourt was the first to got the title of "Apothicaire-Major et Inspecteur des pharmacies des hôpitaux sédentaires", afterwards "apothicaire-major des hôpitaux militaires et des camps et armées".

A famous Inspector was Parmentier, appointed on the 1st Germinal of the year V – 21 march 1797.
In 1786 pharmacists got an own distinctive uniform. Marine uniform

And this is the uniform I have ordered - at a next occasion maybe.

And in 1792, just before the war declaration to the Empire of Austria, the total equality of the three medical corpses has been established – Medicine, Surgery and Pharmacy. A Medical Council was founded in the year II as the supreme instance and it got nine members – three of each corps.

That same year the Military Central Pharmacy has been founded as well. The denomination “pharmacien” became official, as well as the ranks – which were pharmacien-chef (Brigade general), Pharmacien de 1re Classe (Chef de Brigade - Colonel), 2e Class (Captain) and 3e Class (Lieutenant).
In 1804 the Imperial Court Health Service (Service de Santé de la Cour Impériale) has been founded, with as well an Imperial Pharmacy.

The number of French military pharmacists fluctuated continuously in the course of years. In the year III the French Armed Forces counted no less than 345 pharmacists. That large number was ascribed to the multiple tasks of the Corps, including the assistance of the surgeons.
In 1859 we count 168 pharmacists – amongst them one Brigadier Inspector, but a lot of summoned civilians worked as well in the military hospitals and ambulances, especially during the war against Prussia. Pharmacists played a key role in bromatology and food quality assurance as well.

1882 would be the end of the independence of the Pharmaceutical corps and it got submitted to the Medical one. Only after World War I the Corps restored its importance. During that war pharmacists had been active in hospitals, warehouse depots, regional pharmacies, labs and so on, and as well in the so-called Z-Teams in the battle against martial gasses. And especially the fruitful research in that area, mostly in the Pharmacy School restored the dignity of the Corps.
Just to give you an idea, at the beginning of World War I the French Army counted 126 active pharmaciens-chimistes, aside 2193 reservists.

The Marine is another story. Already in 1535 apothecaries took part in overseas expeditions, to Canada for instance. A well-known name is Jacques Cartier. Later, in the 17th Century, the presence of pharmacists aboard Marine vessels was a standard procedure.

In 1931 the function of "apothycaire de l'Amiral destiné à servir auprès dudit seigneur et Grand Maître de la navigation" is mentioned – in a free translation “the Admiral’s apothecary to serve with the named Lord and Grand Master of Navigation”
An odd detail – the salary of navigating pharmacists varied with the number of canons aboard the ship they served on.

To be clear, the navy pharmacists in that time were completely submitted to the physicians. But from 1766 until the Revolution their importance would increase proportional to the number of discoveries of numerous tropical and exotic medicinal substances. And yes, in 1793 the first Pharmaceutical Inspector of the Marine was appointed. Also in the Navy the more scientific denomination of "pharmacien" became a rule since 1798.

A special green uniform was designed, in opposition to the black one of physicians and the red uniform of surgeons. The leading pharmacists obtained large power in the "Conseil de Salubrité" and "Conseil de Santé".- the Hygiene and the Medical Council.  Finally, in 1910 the First Pharmacien Chimiste Général de la Marine has been appointed as well as a General of the Corps of Colonial pharmacists.

Especially during the 19th Century, the classical tasks of pharmacists, working with the Marine and Colonies, were extremely large and embrace:

• Everything which was scientific, the study of wildlife – flora and fauna, meteorology and climatology.

• Fraud fighting

• Analyses of minerals, agricultural and industrial substances (until fertilisers, soil samples and mining samples), bromatology, and toxicology.

• Quality control of water and food supplies.

• General hygiene control (vector elimination, disinfecting and sterilisation

• The study of disease provoking micro-organisms

The consequence of that abundance of tasks explains the large numbers of pharmacist accompanying colonial campaigns.
The Corps looks back in pride to a lot of famous names. We enumerate only some of them:
Hébert: around 1600 the first French colon in Canada, hence his statue in Quebec
Cadet de Vaux: bromatologist and founder of the first French Bakery School (!)

Parmentier: inventor of food chemistry – he promoted the potato as a daily food item, which proved very important in times of starvation due to the failures of grain harvests.

Caventou isolated with Pelletier quinine and strychnine.

Liotard became governor in several colonies and finally of the entire French Occidental Africa – Afrique Occidental Française – in the beginning of the 19th century.

Nowadays, and since 1968, France has a united Medical Service. The Corps of pharmaciens des armées counts 185 individuals, amongst them one division general and three brigade generals ,

The first mentioning of field pharmacists and their mobile pharmacy – the “"Apothekerwagen" can be found in Switzerland around.  
In 1595 the German Emperor prescribed the equipment, and amongst others a coach wagon with "Apodeckerei", with pharmacy department, on which the doctor, the barber and the pharmacist took place  

The first German document which defines military medicine was edited by the Bavarian Kurfürst Maximilian I in 1620. It mentions rights and duties of the several health care officers, including pharmacists. In general the importance of military pharmacists was gaining in the several German states in the middle of the 18th Century, especially under French influence.

PREUSSISCHE APOTHEKWAGEN
Mobile pharmacies were common in Prussia and Bavaria, and often a pharmacist was present in the Royal Head QuarterStaff. The Prussian Army – in 1787 -counted 46 pharmacists, often involved as well in the production. . In the beginning of the 19th Century, in almost all the larger German states (Bavaria, Prussia and Austria-Hungary) proper Military Medical Services were founded. In 1809 the Prussian military surgical staff has been erected, with as members a Surgeon General, a Head Field Hospital Inspector and a Head Field Pharmacist – Oberfeldapotheker

In the Habsburg Empire and in Bavaria we note even the creation of an independent Militärapothenswesens – Military Pharmacy Institutions, with a central pharmacy, regulations and so on. Towards the end of the Century pharmacists were not yet incorporated in the German Imperial Health Corps – that however happened in 1902.

The German Navy had an own pharmaceutical service, with tens of pharmacists working in the colonies.
During World War I no less than 3639 pharmacists participated in the war as military employee. An important post was the Hauptsanitätsdepot Antwerpen – the Central Head Medical Depot Antwerp, installed in the buildings of the fled Belgian Military Head Pharmacy. . Evidently, the German pharmaceutical Corps was involved as well in water preparation, hygiene, disinfecting and analyses. As to martial gasses, towards the end of the war other specialists – special Gasschutzofficiere, have mostly replaced them.

In the colonies Togo, Cameroon, East and South West Africa pharmacist had to be masters in improvisation in their preparation of pharmaceuticals, due to the cutting of the provisioning from the Empire; (15)

Let us stress upon the fact that the Kingdom only exists since 1830 and that – during the previous centuries the country was occupied or colonised by Spain, Austria and France. Between 1815 and 1830 it was a part of the Kingdom of the Netherlands.

The first standing military hospital in the world has been created in 1567 by Margarita de Parma and it was called "Hospital Real del Ejercito de los Países Bajos", Royal Army Hospital of the Netherlands. It did not have a pharmacy and rugs were collected in city pharmacies. Only in 1673 a pharmacy was installed, manned by the civilian Master Norbertus Van Vooren. Here was founded the “Military Pharmaceutical Service of the Army in the Netherlands”, where pharmacists were as well appointed to garrison hospitals.

In 1685 Archduke Albert edited the "Constitutiones del Hospital Real del Exercito de los Paises Bajos". These hospital regulations count 14 articles dealing with the Boticario y sus Obligaciones – the pharmacist and his obligations. It was typical that the pharmacist had to be present at the administration of medicaments to the patients in order to “see to it that the patient takes them well and to recuperate non used drugs”.

In a study about Mechelen (Malines) there is mentioned an ordinance on behave of Empress Mary Theresa after the complaint of the city pharmacists. This paper confirmed the monopoly of drug selling, with a special indication for monasteries and the military surgeons of the garrison. The “New Ordinance upon the fact of the deliverance of medicaments by cloisters, military as others, granted by Her Majesty” was enacted March the 16th 1772

Military Hospital Mechelen

The French Convention decided to affect a number of pharmacist in every army hospital, without any special qualification. Technically they formed a corps, which, in every army was supervised by a head pharmacist. Since 1792 the pharmaceutical corps had gained equality with the medical and the surgical corpses.

During the French reign there were a lot of military pharmacists, and they acted as well as anaesthesiologist. The first mentioned Belgian pharmacist joining the French Health service in 1799 was Joseph Alleweireldt from Bruges. Until 1803 he worked in the hospitals of Gent, Antwerp, Bergen-op-Zoom, Gent again, Brussels and Bruges, where he left service to become a physician in Paris. Afterwards he started a hospital, but in 1831 he would join the newborn Belgian army as a pharmacist 2nd class in Brussels.

In 1814 at the formation of the new unified army of the Netherlands, 48 Belgian health officers joined in; six among them were pharmacists. They kept the rank obtained in the French Army. In 1815 a Military Medical School was erected in Leiden. With 2 pharmacist- professors. War was announcing itself – Waterloo came into sight, and the number of Belgian – or better South-Netherlands pharmacists fell down to 3.

After the Battle of Waterloo almost only South-Netherlands pharmacists would work in the military hospitals in the later Belgium. In 1817 we count already 48 pharmacists, but a physician, the inspector general, performed the inspection. But the Dutch started with downsizing the Medical service in the South and the status of medical officers decreased considerably. A lot of so-called honorary dismissals are noted. At the outbreak of the Belgian Independence Revolution only 4 pharmacists were in service, three of them in the colony of Dutch India – the actual Indonesia.

At the creation of the Belgian Provisional Government a committee was formed with 4 members- one pharmacist, the first Belgian Military Pharmaceutical Inspector van den Corput, who would leave the army soon to become university professor.  His successor was Verzyl, but after a fight with the medical inspector he has been parked in the province.
I will not expand on this subject, but restrain to the third – Clementz – with a remarkable biography.

His born Dutchman started as a pharmacy assistant in the army of Emperor Louis-Napoleon, participates in the Russian campaign, was captured, has been liberated in the Camp in Leipzig in 1814 and joins the Dutch Army. So he is involved as well in the Battle of Waterloo. But at the creation of Belgium, he decides to join the new kingdom and to change nationality. And to become head pharmacist until 1855.

January the 5th the Provisional Government acknowledged 4 corpses – health officers (pharmacists and physicians together), veterinarians, nurses and medical administrators.

During the Great War a lot of pharmacists served in several emergency and field hospitals.

The 25th September 1914, at the outbreak of the War, the Military Central Pharmacy got the order to leave Antwerp. With a part of their reserves and material they left for Calais via Zeebrugge, partly by train, partly by boat. They reassembled aboard the mail boat “Ville de Liège”.

Military pharmacists established fixed liaisons in Paris and London in order to obtain urgent provisioning.  The personal staff in Calais grew quickly and satellite workshops were installed. The city council of Calais placed the municipal lab to the disposal of two Belgian military pharmacists. In 1915 they founded a bacteriology lab also available for civilians. 

In 1918 the main activities stand became Le Havre, with, afterwards a forward post in Bruges, in order to organise the medical provisioning of the newly recreated military hospitals after the reconquest of the territory.

In 1919 the Central Pharmacy was reinstalled in Antwerp with. The first inspector of military pharmacies after the war has been nominated general major – the only general the Corps has had
November 1939, in full mobilisation it was decided to transfer the depots and the material section to Bruges, and in Vilvoorde, near Brussels a pharmacy was installed for the field army. After the war, the Central Pharmacy was reinstalled and it got most of their supplies from the allied countries.

From the scientific point of view, we note the founding by Military pharmacist Dulière of the first lab for bacteriology. During the war, military pharmacists analysed the German martial gasses and developed the principle of protection against those.

Since then NBC maintains to be an action field of the pharmaceutical corps. In the years 45-50 several Belgian military pharmacists are active in several Belgian and foreign research centres for war gasses. Until the seventies some outstanding researchers are worth to be mentioned like Couvreur and Pochet, and nowadays a new draft is occupied in the field. Thanks to colonel Defalque clinical biology would as well become a pharmaceutical discipline in the Army.

In the Scandinavian countries, the Netherlands and the Anglo-Saxon countries, the role of military pharmacists was mostly restricted to proper pharmacy and medical provisioning.

But as shown previously, their role was much wider in Spain, France, the German Territories and Belgium: hygiene management, drug production, control and delivery, advising functions, management of medical material, NBC issues, clinical biology, bromatology, water analyses etc.
Specialisation is sometimes contra-productive in the Armed Forces.  Insects are overspecialised – the medical service and hence the pharmaceutical corps has to be polyvalent.

The classical tasks change of course. Operability and mobility still are key words, but newer terms are mobility, interoperability, communality, quick action, air transportability... and of course downsizing, outsourcing, budget cuts, military pharmaco-economics. And crisis management – “Doctor, tell me what you need, and I will tell you how to do without it.”

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