MEDICAL MATTERS:By MUIRIS HOUSTON
“It was a veritable apothecary’s paradise
He waited by the counter inhaling slowly the keen reek
of drugs, the dusty dry smell
of sponges and loofahs”
– Ulysses, James Joyce
JOYCE WAS referring to Sweny’s Pharmacy at 1 Lincoln Place, opposite the back entrance to Trinity College Dublin. Leopold Bloom was the inhaler in question and he subsequently purchases a soap cake of “sweet lemony wax” from the pharmacy.
While a student at TCD, I passed by the then working pharmacy frequently. But it wasn’t until some years later that I first entered the premises and was immediately bowled over by the fabulous layout of mahogany counters, intricate drawers and pharmacy bottles of all hues and shapes. It was a veritable apothecary’s paradise, a rarity at a time when the typical pharmacy was full of glass counters and had a neutral smell. Oh, the smell. Close your eyes and you were transported to a world of spices, tar, powders and perfume. Here was a place where ointments and cough bottles were carefully made up on site, probably using formulae handed down from master to apprentice.
It’s a far cry from the modern pharmaceutical industry, which must produce capsules and liquid formulations to strict quality control standards. I suspect the mortar and pestle, the age-old emblem of pharmacy, are rarely used in today’s chemists’ shops. However, it’s not a skill that has been dispensed(!) with entirely.
Compounding is still carried out by pharmacists to fit some unique need. This may involve changing formulation from tablet to liquid or the removal of a non-essential ingredient to which the patient is allergic. It could be simply to add a favourite flavour to a child’s medicine.
Compounding was a feature of the Islamic world, with the first apothecary shops opened in medieval times by Muslim pharmacists. In the 19th century, pharmacists isolated different compounds from coal tar and began to extract crude drugs from chemicals. They separated out the active ingredients and began to dispense these as medications, part of the modern medical revolution.
The compounding of most medicines by pharmacists may have become the exception but it still goes on. Skin complaints such as psoriasis and eczema, which are difficult to eradicate completely, have spawned favoured creams and ointments. Coal tar is still a popular and effective ingredient in these, and doctors and patients may wish to alter the ratio of binding agent and emulsifier depending on the particular type or location of a rash. Some people may be unable to swallow tablets because of their condition and so the drug may need to be compounded as a suppository or pessary.
Known in the industry as “specials”, the reduction in pharmacists comfortable with using a mortar and pestle has resulted in specialist firms moving to fill the compounding gap. One such firm is QM Specials, based in Lismore, Co Waterford. Established last year, it claims to have more than 35,000 formulations on file and offers a 24-hour turnaround for any individually compounded “special”. The company speaks of “the unique safety features built into our manufacturing method”.
Poor practice can lead to contamination or to products that don’t possess the strength, quality or purity required for human medicine. Accurate figures are not available but the Food and Drug Administration (FDA) in the US is aware of more than 200 adverse events between 1990 and 2007.
The safety of medicines was almost certainly not an issue for Leopold Bloom in 1922. He and others were more likely to care about the colour and odour of cough bottles and creams offered by Sweny’s. The next time you are passing by Lincoln Place, drop in to the shop. Although no longer a pharmacy – it is in fact run by a group of Joycean enthusiasts on a voluntary basis – it still has the counters, shelves and accoutrements typical of the times. And if you ask nicely, they may even show you some carefully packaged medicines ordered, but never collected by its 1920s customers.