Celebrating the Nation’s 250th: America’s First Hospital Pharmacy

Compounding drugs, seeking operational funding, and administering medications to patients. The nation’s earliest hospital pharmacists shared some duties with today's pharmacists — though they were also, literally, pulling teeth.

To mark the nation’s 250th anniversary, the ASHP News Center looked back at the nation’s first hospital pharmacy, established in 1752 at the Pennsylvania Hospital in Philadelphia, now part of University of Pennsylvania Health System. 

Like a Miniature Apothecary

America’s first hospital opened a year earlier by physician Thomas Bond, his friend Benjamin Franklin, and a group of wealthy Quakers, according to a 1976 article by the late William Williams. 

The hospital was founded with the mission of providing comfort to the “deserving poor,” lower-class working people or their dependents who fell on hard times because of illness, according to a 1994 AJHP article by Gregory Higby, the Fischelis Scholar and former executive director of the American Institute of the History of Pharmacy, located at the University of Wisconsin-Madison School of Pharmacy. 

“It was common in early hospitals to have patrons,” Higby said in an interview. “A rich individual would give money to the hospital, with the idea that their servants and employees could use the hospital.” Wealthier people were more likely to have in-home doctor’s visits.

At first, the hospital’s attending physicians provided medicines to their patients. But by late 1752, the hospital, borrowing a practice common in British facilities, hired Jonathan Roberts as its first apothecary to prepare and compound medicines and administer them “agreeable to the prescriptions of the physicians and surgeons,” wrote Williams. 

Hospital leaders set up shelves in the east backroom of the building as the apothecary area and solicited wealthy widows for funds to pay for the drugs. Like most other early hospital apothecaries, Roberts was an apprentice physician, Higby said. 

“If you look at the early blueprints of the hospital, in one corner the pharmacy is listed on there as ‘shop,’” Higby said. “It was like a miniature apothecary shop, and it was staffed very part time by what we would think of today as an intern.” 

Roberts would have been expected to both run his shop and go on rounds, oversee the hospital library, and perform minor surgery such as pulling teeth, he said.

Roberts’ successor in 1755 was John Morgan, who later became a pivotal figure in American medical history, Higby said. It was Morgan, he said, who first proposed in 1765 that the practices of medicine and pharmacy be separate, as they had been in Europe for centuries.

By the end of the 18th century, the hospital expanded the apothecary even further to keep up with the increase in patients, signing an indenture contract in 1791 indicating an apothecary's apprentice would come on board to "readily obey the apothecary and keep their secrets," according to an article from Penn Medicine. By 1808, records show, hospital surgeons asked for an additional apothecary.

On the formulary: Peruvian bark, castor oil, and “mother’s friend”

Patients and physicians at the time commonly were looking for help with fevers, rheumatism, and stomach ailments, or asking for something for a sick child, said Callie Stapp, a curator with the Stabler-Leadbeater Apothecary Museum in Alexandria, Virginia. “A lot of times, [apothecaries are] just guessing, and they get it right, which is pretty great, considering,” she said. 

While records of prescriptions mixed by Roberts and his successors are missing, available remedies stocked at a colonial-era apothecary were far simpler than today’s formularies. Most consisted of plant-based options, Stapp said. 

For example, castor oil was used for rheumatism and arthritis, “sweet oil” made from olive or almond oil was used for soothing burns, and jalap, a plant found in Mexico, was used as a laxative. Peruvian bark from the Cinchona tree was ground up and strained into a liquid base, sometimes with wine, as a treatment for fevers and malaria, with quinine being the key curative element of the bark, Stapp said. 

Other selections included calomel (mercurous chloride), used for general stomach pains; sarsaparilla, a root usually served in tonic form for rheumatism; and laudanum — the liquid form of opium — for pain relief.

Additionally, colonial-era apothecaries imported from London some popular patent alcohol- or opium-based medicines — marketed that way because the recipes were considered secret — said Stapp. 

These products, widely advertised in newspapers, had brand-name recognition with the public and included Bateman’s Drops, marketed as a general cure-all; Godfrey’s Cordial, an opium-based product given to infants and children for pain (but widely known as a “mother’s friend” for calming children); and Hooper’s Pills, promoted as a curative for “women’s complaints.”

The elite of the hospital staff

The Pennsylvania Hospital purchased its drugs initially from a firm in London, in exchange for an expected donation to the hospital. But by 1769, thee hospital was unhappy with the prices — and a lack of a donation — and turned to local purchases, Williams wrote. Colonial Philadelphia was replete with apothecaries, and it’s likely the hospital could have bought some supplies from them, Stapp said.

The American Revolution ended the dependence on England for drugs, Williams wrote. After that time, the hospital purchased most of its medicinal supplies from American sources.

In the early days, the hospital’s pharmacists were the highest salaried members of the staff, Williams wrote. These early pharmacists, he wrote, “represented the elite of the hospital’s salaried staff and carried out their duties in a responsible manner.”

Pharmacists at the hospital became more specialized as the years progressed. By the mid-19th century, Williams noted, professional pharmacist were respected specialists on the medical teams of the Pennsylvania Hospital and others across the young nation. And the apothecary space itself? It has been restored as part of the Pennsylvania Hospital Museum, which opened to the public earlier this year.