The first clinical pharmacology unit in the world was probably founded in Vienna in 1911

Abstract

The history of clinical pharmacology as a standalone medical field is a topic that comes up rather often at various clinical pharmacology symposia, perhaps because the recent discussion about its future [1,2] needs to be rooted in the past. While clinical pharmacology as a concept, in the guise of material medica, is centuries old [3], the term clinical pharmacology itself is rather young coming with the advent of synthetic and purified drugs at the beginning of the 20th century. Early partial progress in understanding the mechanisms of action allowed experimental pharmacology to translate its findings into clinical practice. The next leap in the development of clinical pharmacology came with the arrival of new drug groups (e.g. antibiotics, antihypertensives, cytostatics, psychoactive drugs) and the ability to measure drugs concentrations thanks to progress in analytical methods after World War II [4]. In one his papers on this topic, Aronson [3] places the origins of the term clinical pharmacology to 1914 in the English translation of the German textbook by Meyer & Gottlieb [5]. While the boom in clinical pharmacology with many standalone departments came after World War II, the first pioneering clinical pharmacology department applying knowledge gained by experimental pharmacology in clinical practice already existed before World War I. In contrast to departments founded in the second half of the 20th century which took on the multiple roles of clinical pharmacology as we know it today (pharmacokinetics, clinical trials and drug development, pharmacoepidemiology and drug safety, economics, etc.), the original departments were motivated by the sole goal of applying the recent findings of experimental pharmacology in clinical practice, and thus replacing the former purely empiric approach with a more scientific one. Until recently, we were convinced that the first physician to practice clinical pharmacology by applying knowledge acquired by experimental pharmacology in clinical practice was Professor Dr Emil Starkenstein (1884–1942) [6,7]. As a young associate professor (docent) of pharmacology at the German medical faculty of the German part of Charles University in Prague, at the time of World War I (1914–1918), Starkenstein served as a commander of the Army infectious disease hospital in Radom in Poland (Kommandant des k.u.k. Epidemiespitals in Radom), where he applied his knowledge of anti-inflammatory effects of Atophan (cinchophen) gained from his experimental work [8,9] to treat successfully epidemic typhus, reducing mortality to 2.5% from 16% [10,11]. In a similar fashion, he applied theoretical knowledge of the adsorption effects of carbo animalis in the treatment of dysentery and cholera [9]. On March 16 1918, Starkenstein presented a lecture titled Klinische Pharmakologie – Theorie und Praxis am Krankenbette (Clinical Pharmacology – Theory and practice at the patient's bedside) at a meeting of Austrian army physicians (‘Feldartzliche Abend’) in Lublin (Poland). In the same year, the full text of the lecture was published in the journal Therapie der Gegenwart [12]. Recently we came across publications by Dr Hans Januschke [13,14] that place the origins of both the term clinical pharmacology and the first pharmacology unit even earlier to 1911.