A/Prof Chris Doecke BPharm PhD FSHP

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The Evolution of Pharmacy at Royal Adelaide
Hospital
SA Medical Heritage Society

• A/Prof Chris Doecke BPharm PhD FSHP

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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

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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

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The Evolution of Pharmacy

• Manufacture and supply of medicines
• -gt now ALSO
• Improving medication management for patients
  directly through the provision of medicines
  information

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Ebers Papyrus 1550 BC

• 811 Prescriptions
• Treatments for
• Asthma
• Depression
• Dementia
• Heart ailments
• Chapter on Contraception

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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

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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

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Frederick II von Hohenstaufen - Holy Roman
Emperor (1220 1250)
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Constitutiones Imperiales - 1231 AD

• dogmatic medicine, which made diagnoses
• manual medicine, which performed surgical
  interventions and
• pharmaceutical medicine, which collected, mixed
  and conserved medicines.

Frederick II von Hohenstaufen
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Constitutiones Imperiales - 1231 AD

• 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

Frederick II von Hohenstaufen
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Dr Alexander Charles Kelly

• Scottish Medical Practitioner
• Struggling medical practice in Port Adelaide
• First Resident Dispenser
• Adelaide Hospital
• June August 1842

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Dr Alexander Charles Kelly - Winemaker

• August 1843 80 Acres at Morphett Vale
• Planted first vines
• Built house Trinity
• Wrote two books
• The Vine in Australia (Melbourne, 1861)
• Wine-Growing in Australia (Adelaide, 1867)
• Both influential books that did much to establish
  Australian technical expertise in viniculture

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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

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Charles James Carleton

• Studied medicine at Guys Hospital
• Didnt complete degree
• Left England for Adelaide with wife and children
  in 1839
• Resident Dispenser until 1845
• Became Medical Practitioner in Kapunda

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CAROLINE CARLETON
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Dr Robert Travers Lewis

• Resident Dispenser and House Surgeon
• 1845 1847
• All Resident Dispensers at the Adelaide Hospital
  until 1847 had a medical background

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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

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RAH Pharmacy Service - Chief Pharmacists
since 1899
George Burns

• 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

Lance Jeffs
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RAH Pharmacy Services 1899 -gt
early 1970s
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The Advertiser - Friday 16th June, 1911
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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.
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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.
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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.
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Production Services
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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.

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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

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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

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The Sterile Eye Drop

• Official Initial Responses
• "the sterilisation of eye drops is unnecessary
• "not in practise possible"

Mr DO Crompton Eye Surgeon
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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

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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

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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

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Drug Formulary Therapeutic Handbook

• Regular printed editions
• Now on-line

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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

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The Medication Management Cycle
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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

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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

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Royal Adelaide Hospital
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