Principles and Practice of Pharmaceutical Medicine

at the age of 14, graduated BA in 1728, became an
marketing authorization (MA) in 1732, and
obtained his MD in 1739. Heberden published his
Essay on Mithridatium and Theriacin the same
year as he obtained his FRCP. William Heberden
founded theMedical Transactions of the Royal
College of Physiciansin 1767 and in the first
three volumes, 1768–1785, he published 16
papers. Heberden is known for his description of
Heberden’s asthma (cardiac asthma) and Heber-
den’s nodes, which are calcipic spurs on the articu-
lar cartilage at the base of the terminal phalanges
in osteoarthritis. He made the clear point that
they had no connection with gout, which was the
main and highly fashionable arthritic ailment of his
time. Heberden died in 1801 and was buried in
Windsor Parish Church, where there is a memorial
plaque to him and his son William Heberden
Junior, who was physician to George III during
his years of insanity, which we now believe was
due to porphyria.
The 1746London Pharmacopoeiawas thelast in
which mithridatium and galene appear; they were
absent from the 1788 edition. TheEdinburgh Phar-
macopoeia, first published in 1699, dropped
mithridatium and galene from the 1756 edition.
Not all Western European countries were so
quick to expunge these formulations, for galene
with its vipers appears in theGerman Pharmaco-
poeiaof 1872 and in theFrench Pharmacopoeiaof
1884.Withthedisappearanceofmithridatiumfrom
theFrenchPharmacopoeia,thelong-usedcomplex
remedyattributable toanexperimentaltoxicologist
from the first centuryBCcame to an end.
Prior to the doubts on the efficacy of mithrida-
tium raised by a number of English physicians,
including Culpepper and Quincy, and culminating
in William Heberden’s attack and condemnation
of these products, there had been occasions
when these formulations had been noted to be
ineffective. In all these circumstances, it was
believed that the formulations had been inade-
quately compounded; or that the quality of the
ingredients was suspect (the quality of cinnamon
was frequently raised); or even the species of viper
used in theriac was questioned. These concerns to
maintain the quality of mithridatium and theriac
led to the introduction of strict controls over the

quality of ingredients and blending. For example,

the manufacture had to be done in public in Venice

and the ingredients had to be open to inspection.

Pharmacopoeias were produced, which laid down

standards, not only for mithridatium and theriac,

but for other therapeutic substances. Perhaps, in the

final analysis, the contribution of mithridatium and

theriac to modern medicine was that concerns

about their quality stimulated the earliest concepts

of medicine regulations.

TheMedical and Physical Journal, one of the

earliest to supply regular information on new work

in medicine, pharmacy, chemistry and natural his-

tory, suggested in its first volume in 1799:

...wewould submit to the legislature the propriety of

erecting a public board composed of the most emi-

nent physicians for the examination, analysation and

approbation of every medicine before an advertise-

ment should be admitted into any newspaper or any

other periodical publication and before it should be

vended in any manner whatsoever.

By the end of the 18thCentury all the ingredients for

an efficient regulation of medicines had been con-

ceived, but in a piece-meal fashion (see Table 2).

What was missing was the integration into a single

scheme. This would have to wait until the passing of

the Medicines Act (1968) and its implementation on

1 stSeptember 1971.

33.2 The nineteenth

and twentieth centuries

to the Medicines Act 1968

Compulsory vaccination against smallpox was

established by the Vaccination Act of 1853 after

the report compiled by the Epidemiological

Society on the state of vaccination following the

first Vaccination Act of 1840. The 1840 Act had

provided free vaccination for the poor to be admi-

nistered by the Poor Law Guardians.

Under the Vaccination Act of 1853, all infants

had to be vaccinated within the first three years of

life, default of which meant the parents were liable

to fine or imprisonment. New legislation incorpo-

rated in the Vaccination Act of 1867 made it

422 CH33 THE DEVELOPMENT OF HUMAN MEDICINES CONTROL IN EUROPE