In the Footsteps of Scribonius Largus, a Pioneer of Clinical Pharmacy in Ancient Rome

Clinical pharmacy involves pharmacists in direct patient care concerning optimizing medicines and promoting health awareness and disease prevention. The whereabouts of the field can be traced to Scribonius Largus, a renowned physician and pharmacist in ancient Rome. Although Largus served as an imperial physician, he has also been an exemplary pharmacist authoring a comprehensive pharmacognosy textbook and dedicated a big part of his life to improving pharmacotherapy and advancing ethics in the field. Revisiting his contributions provides valuable lessons for contemporary clinical pharmacists.

from infectious outbreaks emerging within the imperial territory or spread by populations crossing the border 5 .
The pharmacy was rather empiric. Eminent physicians and scientists such as Galen and Plinius provided written accounts of pharmacotherapy and pharmacognosy at the time. In many cases, physicians acted as pharmacists preparing and administering formulations suitable to the diagnoses they made. They would use natural compounds of either animal or plant origin. However, it was within the power of such practitioners to amend the documented pharmacotherapies or invent new ones 6,7 .
Frequently, this would lead to risky practices because folk or fraudulent practitioners would provide therapies of their own, exploiting the need of people to find a cure.
Emperors and the nobility would employ the most capable physicians and pharmacists and provide them with the means to practice their treatment skills at individual or population levels. Scribonius Largus was the physician-pharmacist of Emperor Claudius, who reigned between 41 and 53 AD 8, 9 . In an era when the roles of physicians and pharmacists were hardly distinct, Largus made significant contributions in summarizing the pharmacognosy of his time, prompting evidencebased pharmacotherapy and related policy and ethics 10 .
The present review aims to present the biography of Scribonius Largus and highlight his contribution to clinical pharmacy in his era and in modern times.

BIOGRAPHY OF SCRIBONIUS LARGUS
Scribonius Largus (14-54 AD) was a physician of Greek origin who served in the court of Emperor Claudius as a personal physician (10-54 AD) and also accompanied him on his campaign in Britain 11 . In 47 AD, Gaius Julius Callistus, an imperial statesman, requested him to put together a list of pharmaceutical preparations covering the known disease spectrum of the period. Little is known about the whereabouts of Largus, his family background, his life events, or his death. Information about him derives from the writings of physicians, philosophers, or historians. Although some scholars consider him a fictional character, the fact that prominent Greco-Roman physicians and authors, such as Galen, mention him in their works proves his existence 12 . It is worth note, however, that Largus, apart from his contribution in medicine and clinical pharmacy, is well known for his contribution in the field of Medical Ethics, which also proposes a code of conduct for physicians which includes concepts such as mercy and humanity 13 .

An innovative pharmaceutical textbook
The

Largus as a clinical pharmacist and practitioner
Largus made the best of his proximity to the imperial court and its ample resources to collect as much Largus probably used his prestige in order to overcome his opponents and their infamous beliefs and practices.
Other physician-pharmacists would not be able to do so, even if they shared his commitment to the best available evidence. Largus made the best out of his affiliation with his era's stakeholders. Evidently, he had a good grasp of the bigger picture of power dynamics beyond his field.
On top of this, the fact that he did not use this affiliation to promote his agenda or create an extensive memorial of his name indicates his ethical qualities. He vigorously attempted to include the same qualities in his written patrimony to future generations stating that "all men and Gods, in fact, should despise any physician whose heart is not full of humanity and mercy according to the purpose of his profession" 24 . It appears that Largus must have been a competent and upstanding scientist 3 .

DATA AVAILABILITY
None.