The history of pharmacy in the United States is the story of a melting pot of new pharmaceutical ideas and innovations drawn from advancements that Europeans shared, Native American medicine and newly discovered medicinal plants in the New World. American pharmacy grew from this fertile mixture, and has impacted U.S. history, and the global course of pharmacy.
Apothecary—an ancient title that, especially in pre-modern or early modern contexts, indicates a broader set of skills and duties than the core role of dispensing medications, like prescribing remedies and even giving some treatments difficult to self-administer, e.g. enemas—have largely been within the "pharmacist" umbrella in the U.S. since the mid-19th century, when Edward Parrish of the American Pharmaceutical Association successfully proposed that the APhA "consider all the varied pharmaceutical practitioners 'pharmacists'” to better "standardize the field." Unlike in the UK, where pharmacists were separated from apothecaries by Parliament and the pharmacist had effectively eclipsed the ancient apothecary, appellations and professions have been far more fluid and overlapping in the U.S., especially prior to the regulatory schemes widely adopted in the late 19th century. "Apothecary" still crops up as synonym for pharmacist, along with "druggist," and has yet to fall entirely out of use, with some in the U.S. still calling themselves apothecaries. As the pharmacist increasingly became the distinct discipline and tightly defined profession it is today, American pharmacists added their own discoveries and innovations, and played a prominent role in the revolution in medical knowledge in the 19th and 20th centuries and the subsequent development of modern medicine.
The history of pharmacy has lagged behind other fields in the history of science and medicine, perhaps because primary sources in the field are sparse. Historical inquiries in this area have been few, and unlike the growing number of programs in the history of medicine, history of pharmacy programs remain few in number in the United States.
Colonial period
Early developments alongside colonization As soon as Columbus started his explorations of the Americas in the late 15th century, a European effort to find valuable medicinal plants among the flora of the New World to add to the medical canon got underway. Early New World medicines uncovered included guaiacum from the West Indies (for coughs, rheumatism and a wide variety of other uses), sassafras from Florida, copaiba from Brazil, Peru balsam and, most famously, cinchona bark from Peru, also called "Jesuit's bark" in honor of its discoverer, which became the first effective treatment for malaria. The active ingredient of this cinchona bark, quinine, was the primary treatment for malaria well into the 1940s. "About 170 drugs used by the Indians of British North America, and perhaps 50 used by the indigenous people of the Caribbean, Mexico, Central and South America" became important enough in the U.S. (as the practitioners of chemistry and pharmacy eventually catalogued, analyzed and understood them) to merit listing in the United States Pharmacopoeia (est. 1820) or the National Formulary.
In the early 1700s, James Oglethorpe, founder of the Georgia colony, with the financial backing of the Worshipful Society of Apothecaries of London and others, launched an effort to identify and transplant beneficial plant species from the tropical colonies to Savannah, Georgia. Unfortunately for Oglethorpe (and all the Southern colonists) the expedition that marked this first attempt by an organized group of Old World apothecaries to benefit from British North America's potential as a medicine farm never bore fruit. The Caribbean expedition's lead investigator, botanist Robert Miller, was hampered by illness and uncooperative Spanish colonials, and all support from London ceased when Miller died without much success.
Pharmacy in eighteenth-century North America The first "drugstores" in North America "appeared in Bethlehem, Pennsylvania, Boston, New York, and Philadelphia," with likely proto-drugstores—for example Gysbert van Imbroch ran a "general store" that sold drugs from 1663 to 1665 in Wildwyck, New Netherland, today's Kingston, New York—preceding the dedicated apothecary shops of the 1700s, and providing a model. Because of that model, and customs that stretch back to the first apothecary shops in the medieval Arab world most drugstores continued selling more general goods, perfumes, cosmetics, and drinks of all sorts alongside medicines, and still do.
Non-British influences That the Spanish colonials, not the British, were the first in North America to license a pharmacist (in 1769 in New Orleans) and were also the first to regulate pharmacy as a separate profession, points to the importance of non-British colonial governments and, indeed, settlers from mainland Europe throughout North America, in importing and translating the more modern pharmacy methods, standards and ways of organization and regulation—developing in Europe since at least the 1600s—for application in the infant United States.
"Franco-Spanish" Louisiana "more clearly reflected [pharmacy's] development in Continental Europe." Influential milestones achieved in 18th-century Louisiana included the February 12th, 1770 edict from the governor in New Orleans, Don Alexandre O'Reilly, delineating the responsibilities and boundaries of medicine, surgery and pharmacy and marking the first legal recognition of pharmacy as a distinct discipline in the territories that would become the United States. Though the number of pharmacists licensed under this system in Spanish Louisiana never surpassed the single-digits, O'Reilly's decree and its ethical code for pharmacists set an important precedent future developments would build upon. It also brought on-line an important independent pipeline of licensed druggists, albeit a small pipeline, to add to the scant supply of Old World apothecaries who had immigrated to set up shop in the colonies.
Of the few apothecaries imported from Europe, those of Jesuit training had a long-felt impact in both New Spain and New France; so great was Jesuit involvement in "care of the sick" in their foreign missions, in fact, they sought and received a papal exemption from the ban on clerics serving in medical roles. Two dedicated "pharmacopoles or apothecary brethren" Jesuits are listed under the heading "Missions of North America in New France" in Society of Jesus personnel records for the "Province of France at the End of the Year 1749." Jesuit contributions, especially in translating Native American ethnobotany into medicines for European use, were highly influential as pharmacy developed in North America.
In British North America Pharmacist Ambrose Hunsberger, in his sweeping introduction covering pharmacy's development in the United States prior to the events discussed in his 1923 article on Prohibition's impact, "The Practice of Pharmacy Under the Volstead Act," described pharmacy before its organization (which he places around 1821) in terms that evoke the snake oil salesmen and medicine shows that hit every town, hamlet and village in the country: "...the disorganized system of hawking medicinal remedies which prevailed throughout our thinly populated country. There was no method of protecting the public from fraud through control or regulation of the sale of adulterated and harmful medicinal products, and the credulous citizenry of the young nation was beguiled by every description of fakir and charlatan into buying their fantastic panaceas." Hunsberger puts the practice of "more or less methodical" pharmacy in Europe "two or three centuries" back, as early as the 16th or 17th century, whereas he places the start of organized pharmacy in the United States with the founding of America's first formal college of pharmacy, the Philadelphia College of Pharmacy (PCP), in 1821.
Prior to this, however, the original British colonies retained a much more ad hoc, improvisational approach to pharmacy, and "there were, as was to be expected in a land so vast and so sparsely settled, virtually no limitations as to where or by whom pharmacy could be practiced." Lines between the professions of pharmacist, wholesale druggist and physician did not yet exist in the way they would later; "their provinces overlapped, and appellations, which often meant little, frequently changed." In the colonial and early independence years, necessity demanded a do-it-yourself approach to pharmacy. "Most, if not all, American medical men prepared and dispensed their own medications, since fee bills and custom usually provided fees for the medication and not the visit, unless surgery or delivery was involved." Thus, oftentimes the doctor was the apothecary and the apothecary the doctor, especially among rural "country doctors" who predominated in this era of farmers with "freeholds" thinly dotting the colonies. "Even in the 1760s, when a younger and largely native born cohort of physicians returned from Europe, most of the reputable and even famous among the American medici ran their own pharmaceutical business," which, for most doctors for the bulk of the 18th century included mostly medications mixed and dispensed by hand, sometimes augmented with a supply of patent medicines imported from the UK or mainland Europe.
In the cities, the foundations of commercial pharmacy were slowly building. By 1721 there were "14 apothecary shops in Boston," and the first "commissioned pharmaceutical officer in an American army" was the Boston apothecary, Andrew Craigie. A sort of warrior-apothecary, he took part in the Battle of Bunker Hill, June 17, 1775. And "when Congress reorganized the Medical Department of the Army in 1777, Craigie became the first Apothecary General."
Important early American "apothecary shops" include the one in colonial Fredericksburg run by later-brigadier general in the Continental Army, Hugh Mercer, (the building is now a museum, and has been "scientifically dated" to 1771 or 1772). And the Marshall Apothecary (established 1729, open for 96 years) in Philadelphia, which was a manufacturer of medicines as well as a retailer, and served as an important supplier throughout the Revolutionary War. Advertisements from the period indicate "that there were drugstores in virtually all American cities by the end of the eighteenth century."
Economic historian Bernice Hamilton describes the 1700s as having "completely transformed" all "the medical professions," explaining that "advances in medical education and science," the emergence of a robust middle class, "as well as the growth of 'a professional feeling'" had greatly changed the socio-economic order by the end of the 18th century. Thanks to the ruling in the Rose Case back in London, apothecaries began 1705 as fully accredited medical professionals who could write prescriptions. Hamilton notes "…the apothecaries, once mere tradesmen and the 'servants of the physician,' had become practicing doctors," treating patients directly. These trends spread to the colonies, and though apothecaries never organized into a legally distinct and guilded profession in North America, the rural hinterlands mirrored the prevalence of the apothecary in Britain, where "in more remote locales, the apothecary 'was usually the only doctor.'"
The pharmacopoeia, which simply lists useful drugs—or sometimes more importantly, drops questionable substances from the canon—"came fully into its own in the early modern age", encompassing roughly the span of history covering the 1500s up until the French Revolutions in the late 1700s. But pharmacopoeias mainly offered some basics and compounding instructions.