The Evolution of Pharmacy at Royal Adelaide Hospital

1. A/Prof Chris DoeckeBPharm PhD FSHP The Evolution of Pharmacy at Royal Adelaide Hospital SA Medical Heritage Society 1

2. Pharmacy at RAH– Back to the Future • Statewide Clinical Support Services • Part of SA Pharmacy since July this year • Service Level Agreement between SA Pharmacy and Central Adelaide LHN 2

3. Pharmacy at RAH– Back to the Future • First lay appointment to the Adelaide Hospital • Dispenser • Mr J Weston and then John Slatter in 1840 • External providers – fee based on service agreement • 1842 – Adelaide Hospital – First Resident Dispenser 3

4. The Evolution of Pharmacy Manufacture and supply of medicines -> now ALSO Improving medication management for patients directly through the provision of medicines information 4

5. Ebers Papyrus ~ 1550 BC • 811 Prescriptions • Treatments for • Asthma • Depression • Dementia • Heart ailments • Chapter on Contraception 5

6. Ebers Papyrus ~ 1550 BC • Remedy to clear out the body and to get rid of the excrement in the body of a person • Berries of the Castor Oil Tree • Chew and swallow down with Beer in order to clear out all that is in the body 6

7. Pharmacy and Medicine • Caliph al-Mansur (754 – 774 AD) • Abbasid dynasty of the Islamic Empire • Separation of Pharmacy and Medicine • Benefits for patients • First known Pharmacy • Bagdad 770 AD 7

8. Frederick II von Hohenstaufen - Holy Roman Emperor (1220 – 1250) 8

9. Constitutiones Imperiales - 1231 AD Frederick II von Hohenstaufen dogmatic medicine, which made diagnoses; manual medicine, which performed surgical interventions; and pharmaceutical medicine, which collected, mixed and conserved medicines. 9

10. Constitutiones Imperiales - 1231 AD Frederick II von Hohenstaufen • Medical Education • Required a public examination before the Masters of Salerno for a licence to practise medicine was granted • Four year of pre-training in logic • Five years of medicine • One of these being surgery and anatomy to practise surgery • One year of practical training under an experienced physician 10

11. Dr Alexander Charles Kelly • Scottish Medical Practitioner • Struggling medical practice in Port Adelaide • First Resident Dispenser • Adelaide Hospital • June – August 1842 11

12. Dr Alexander Charles Kelly - Winemaker • August 1843 – 80 Acres at Morphett Vale • Planted first vines • Built house – “Trinity” • Wrote two books • The Vine inAustralia (Melbourne, 1861) • Wine-Growing in Australia (Adelaide, 1867) • Both influential books that did much to establish Australian technical expertise in viniculture 12

13. Dr Alexander Charles Kelly - Winemaker • Formed the Tintara Vineyard Co with • Sir Thomas Elder • Alexander Elder • Sir Samual Davenport • Robert Barr Smith • Sir Edward Stirling • 1863 - Started clearing 213 acres heavily wooded area near McLaren Vale • Eventually sold to Thomas Hardy in 1877 13

14. Charles James Carleton • Studied medicine at Guy’s Hospital • Didn’t complete degree • Left England for Adelaide with wife and children in 1839 • Resident Dispenser until 1845 • Became Medical Practitioner in Kapunda 14

15. CAROLINE CARLETON 15

16. Dr Robert Travers Lewis • Resident Dispenser and House Surgeon • 1845 – 1847 • All Resident Dispensers at the Adelaide Hospital until 1847 had a medical background 16

17. Mr Henry Briggs • First Resident Dispenser without a medical background • Long career from 1847 - 1873 • Wife Mrs Henry Briggs • Nurse at Adelaide Hospital 1849 • Appointed Matron in 1855 17

18. RAH Pharmacy Service - Chief Pharmacists since 1899 George Burns Lance Jeffs Mr William Hammer ~ 40 years Mr George Burns ~ 30 years Mr Lance Jeffs ~ 3 years Mr Ian Lee ~ 20 years Dr Chris Doecke 19 years 18

19. RAH Pharmacy Services 1899 -> early 1970s 19

23. The Advertiser - Friday 16th June, 1911

24. A DISPENSER'S END. VICTIM TO MORPHIA AND COCAINE. The City Coroner (Dr. Ramsay Smith) conducted an enquiry into the circum- stances surrounding the death of Thomas John Fridy, at the Adelaide Police Court on Thursday. Fridy was assistant dispenser at the Adelaide Hospital, Michael Fridy stated that the deceased was his son, aged 32. For some years past he had been in indifferent health and he had been under two operations. Alfred Herbert Bonney, porter at the Adelaide Hospital said he went to the out patients' dispensary about 3.15 p.m. on June 12 and saw the deceased lying on the floor, apparently in a fit. With help he carried the prostrate man to the consulting room and went for the medical superintendent.

25. Dr. de Crespigny, medical superintendent at the hospital, said when he saw the deceased he was struggling violently and in the witness' opinion was suffering from poisoning. He died in from 7 to 10 minutes after he saw him. The witness suspected he had been taking morphia from time to time, and the deceased told him so about four or five months ago. He had also been taking cocaine lately. Dr. Angas Johnson said he made a post-mortem examination of the deceased and found that all the organs of the body were healthy except the liver, which was affected with hydatids. In his opinion death was due to an alkaloidal poisoning.

26. Dr. de Crespigny examined the dispensary and found all the bottles of the preparations of morphia were empty, also a 6 oz. bottle of sulphate of atropine solution. In ordinary circumstances they would not be empty as they were used daily. Things were much confused on the shelves and on the floor of the dispensary, and the contents of the bottles of drugs had been spilt. The Coroner found that deceased came to his death from poisoning, self administered, while in an unsound state of mind.

27. Production Services 27

28. Eye Drop Sterilisation & Preservation Before 1960 it was believed eye drops needed to be clean but not sterilised. All eye drops were multi-dose, however, preservatives were not used. 28

29. Mr David Crompton - RAH Eye Surgeon Believed contaminated eye drops were the cause of post operative eye infections Was supported by the RAH Pharmacy by preparing sterile eye drops for his research 29

30. Mr PL (Lance) Jeffs Deputy Chief Pharmacist at the RAH at the time Developed chlorhexidine as a preservative for eye drops Published internationally in 1959 30

31. The Sterile Eye Drop Mr DO Crompton Eye Surgeon • Official Initial Responses • "the sterilisation of eye drops is unnecessary“ • "not in practise possible" 31

32. The Sterile Eye Drop Dr Kevin Anderson, Head of Bacteriology, IMVS Eventually in the early 1960s Australia the first country in the world to mandate that eye drops must be sterile 32

33. Late 1960s onwards • Explosion in the number an range of pharmaceutical products available • Great need for independent medicines information • RAH Drug Information Centre • One of the first in Australia 33

34. RAH Drug Committee Established in 1969 Multidisciplinary committee primarily supported by pharmacy Advice to the hospital on drug usage, prescribing trends and new drugs Also linked to the issue of the increasing cost of medicines 34

35. Drug Formulary & Therapeutic Handbook • Regular printed editions • Now on-line 35

36. Clinical Pharmacy Services Requirement for Pharmacists to support medication use at the bedside Support for prescribers Support with medicine administration Support for patients and their carers 36

37. The Medication Management Cycle 37

38. Pharmaceutical Reforms 2009 Commonwealth – State Agreement Aims to improve the continuity of medication management Currently 30 of the 50 RAH pharmacists work fulltime in clinical areas 38

39. Pharmacy Teaching and Research • Formal link between UniSA and RAH • Joint appointment • Director of Pharmacy Services • A/Professor of Pharmacy Practice • Second in Australia in 1994 39

40. Royal Adelaide Hospital 40