Philadelphia Invented the American Drugstore, Then Had to Police It

TL;DR: In the 1800s, anyone could bottle anything and call it medicine. Philadelphia sat at the center of that world. In 1821 a group of city apothecaries started the first pharmacy school in America, in large part to raise the standard of what was being sold. At the same time, one of the country's most famous cure-alls was being made a few blocks away by a former bookbinder, and respected doctors put their names behind it before taking them back. Thirty years before that, during the 1793 yellow fever epidemic, the most admired physician in America stayed in the city to treat the sick and used methods we now know were harmful. None of these people were stupid. That is the useful part. The way they went wrong is the same way people go wrong now, and you can learn to spot it.

Walk down Chestnut Street and you are walking through the birthplace of American pharmacy. That is not a tourist-board exaggeration. The first hospital in the colonies opened here in 1751. The College of Physicians was founded here in 1787. The first college of pharmacy in North America was founded here in 1821.

Philadelphia was also, at the same moment, one of the great centers of American patent medicine, which is the polite historical term for bottles of unregulated liquid sold with enormous promises on the label.

Both of those things being true in one city, at one time, is the story. It is also the reason this history is more than a curiosity. The questions that Philadelphia was arguing about two hundred years ago are the questions in front of you the next time an ad promises something your doctor has not mentioned.

Why did Philadelphia become the center of American medicine?

Money, ports, and Quakers, roughly in that order.

Philadelphia was the largest city in the young country and its temporary capital. It had the shipping to import materia medica from around the world and the wealth to support apothecary shops. It also had a Quaker merchant class with a strong culture of practical education and public benefit.

In 1821, sixty-eight of the city's apothecaries, most of them Quakers, founded what was incorporated the following year as the Philadelphia College of Pharmacy. It was the first institution of its kind in North America, and it still exists today as part of Saint Joseph's University.

Here is the part that gets left out of the plaque. They did not found it because pharmacy was going well. They founded it because the trade was unregulated in every direction that mattered. Anyone could compound and sell a remedy without training, and a customer had little way to know whether the bottle in their hand contained what the label claimed. The school was a quality-control project. Its students spent two years in evening lectures while apprenticing during the day, and the point was to produce people who knew what they were handling.

The first pharmacy school in America was built as a response to a marketplace that had gotten out ahead of anyone's ability to check it. Hold onto that, because it is going to sound familiar.

How did the most respected doctor in America get it so wrong?

In August 1793, yellow fever arrived in Philadelphia. By November it had killed more than 5,000 people out of a city of roughly 50,000. One in ten Philadelphians died in four months.

Most physicians who could afford to leave, left. Benjamin Rush did not. Rush was a signer of the Declaration of Independence, the most famous physician in the country, and by any reasonable account a brave man. He stayed in the city through the worst of it and treated as many as 100 to 150 patients a day while people around him fled or died.

He also believed the fever was a disease of inflamed blood, and he treated it accordingly. He bled patients heavily, arguing in some cases for removing an enormous fraction of the body's blood volume, and he purged them with calomel, a mercury compound, combined with jalap. Patients who were already dehydrated and bleeding internally were bled further and purged harder.

Some of his patients recovered. Yellow fever has a survivable course for many people, and those recoveries were credited to the treatment. The ones who died were understood to have been too far gone. Nobody was comparing those outcomes against a group left alone, and the theory had no way of being shown wrong. It explained every outcome, which felt like strength and was the weakness.

Other Philadelphia physicians disagreed with him publicly and sharply. The argument got ugly, and after the epidemic Rush resigned from the College of Physicians over the criticism.

This is the story worth carrying, and not because Rush was a fool or a fraud. He was neither. He was brilliant, credentialed, courageous, and working from a coherent theory, and the theory was wrong, and he defended it hardest when it was questioned most. Sincerity is not a safeguard. Neither is expertise. What protects patients is a way of finding out you are wrong, and that machinery did not exist yet.

What was Swaim's Panacea?

Around 1820, a Philadelphia man named William Swaim began selling a sarsaparilla-based syrup he called Swaim's Panacea. It was advertised for scrofula, syphilis, and rheumatism, which is to say for a set of feared, disfiguring, poorly treatable conditions where desperate people would try anything.

Swaim was a bookbinder by trade. The origin story he circulated was that he had come across the recipe in the pages of a book he was binding.

The Panacea sold spectacularly, and part of why it sold was that respected physicians endorsed it. Among them was Nathaniel Chapman, who would go on to become the first president of the American Medical Association.

By 1828 the Philadelphia Medical Society had published a report refuting those endorsements, and Chapman was among the physicians who disavowed what they had said earlier. The formulation was understood to contain mercury compounds alongside the sarsaparilla.

The recantation did not matter much. Swaim's Panacea kept selling in one form or another into the 1920s, a full century after it launched, decades after the medical establishment had gone on record against it.

That is the durable lesson. A physician's endorsement is a marketing asset with a long half-life, and taking it back does not retrieve it. The label kept the credibility long after the credential had walked away.

How did a pharmacy student's health tonic turn into root beer?

Charles Elmer Hires was born outside Philadelphia in 1851 and raised Quaker. He worked in a drugstore as a boy, moved into Center City at sixteen to work in a pharmacy, and took classes at the College of Pharmacy.

By 1876 he was selling packets of powder, a quarter each, that made five gallons of a beverage from what he advertised as sixteen wild roots and berries. He claimed it purified the blood and put color in your cheeks. He gave away free glasses of it at the Centennial Exposition in Philadelphia that year and picked up a national audience.

He marketed it as a temperance drink, positioned against alcohol at a moment when the temperance movement was gathering force. Russell Conwell, who later founded Temple University, is credited with suggesting the name that stuck, on the grounds that "root beer" would land better with working people than what Hires had been calling it.

Hires Root Beer was a health tonic that became a soft drink, and the change happened in the marketing rather than in the bottle. That boundary was always more porous than the labels suggested, and the same is true of the wellness shelf now.

So what does any of this have to do with 2026?

The patent medicine era ended in a regulatory sense. Federal law eventually required that labels be accurate and that drugs be shown to be safe and then effective before sale.

What did not end is the category of things sold for your health that sit outside that requirement. Supplements, wellness devices, testing panels marketed directly to you, and protocols sold by people with large audiences are governed much more loosely than drugs are. The claims are softer, the language is careful, and the underlying structure is recognizable: a promise, a testimonial, a credential borrowed from somewhere, and no obligation to demonstrate that it works.

The tomato pill craze of the late 1830s is the sharpest small example. A doctor promoted tomatoes as a cure for digestive complaints, an entrepreneur turned that into tomato extract pills, and the market filled with imitators. Because nobody was checking, many of the copycat pills contained no tomato at all. To make sure customers felt something happening, the makers loaded them with violent laxatives.

That trick has never gone away. A product that produces a strong sensation feels like it is working, and sensation is not the same as benefit.

How do you read a health claim?

Five questions handle most of what you will meet.

Who is telling you, and what do they sell? Not to dismiss them, but to weight what you hear. Somebody who profits from your yes is giving you an argument rather than an assessment.

What would prove this wrong? Rush's theory explained recovery and death equally well, which is why it survived so long. A claim that cannot fail a test is not a finding.

Compared to what? Almost everything looks like it works when the comparison is nothing. Most conditions fluctuate, and most people seek help at their worst, so improvement is the expected path with or without an intervention.

Does the sensation mean anything? Flushing, tingling, a rough day described as detox, a strong taste. These convince people, and none of them are evidence of benefit.

How reversible is it? This is the one that matters most in practice. A cheap, reversible thing with weak evidence and a plausible mechanism is a defensible experiment. Something expensive, permanent, or capable of harm needs much stronger ground before you start.

Guidance from the Clinic

"The reason I find Benjamin Rush more instructive than any of the outright frauds is that he was doing his best. He stayed in a plague city when he could have gone. He worked himself past exhaustion. And he hurt people, because the theory in his head was wrong and there was no mechanism for finding that out. When a patient brings me something they read about, I am not trying to be the person who says no. I am trying to answer a narrower question with them: how would we know if this were working, and how would we know if it were not? If we cannot answer that, we have not got a plan, we have got a belief. I have been wrong plenty. What I want is to be the kind of wrong that gets caught."

Related at Fishtown Medicine

• Why Most Supplements Do Not Work - the modern version of the same problem
• Supplement Quality and Contamination - what is in the bottle you bought
• The Placebo Effect and Social Media - why useless things feel like they help
• The Nocebo Effect - expectation running the other direction
• Peptides: Approved vs Gray Market - where the unregulated market sits right now

Scientific References

1. Mütter Museum, The College of Physicians of Philadelphia. "Benjamin Rush, Bloodletting, and the Philadelphia Yellow Fever Epidemic of 1793."
2. Pennsylvania Center for the Book, Penn State University Libraries. "Philadelphia Under Siege: The Yellow Fever of 1793."
3. Historical Society of Pennsylvania. "What the Doctor Ordered: Dr. Benjamin Rush Responds to Yellow Fever."
4. American Institute of the History of Pharmacy. "From the Collections: America's First College of Pharmacy Now Part of St. Joseph's University."
5. Saint Joseph's University. "Philadelphia College of Pharmacy." Founded 1821; first college of pharmacy in North America.
6. The Library Company of Philadelphia. "Shareholder Spotlight: William Swaim."
7. Encyclopedia of Greater Philadelphia. "Root Beer." Charles Hires, the 1876 Centennial Exposition, and the temperance framing.
8. Pennsylvania Center for the Book. "Hires Root Beer: The Great Health Drink."
9. Encyclopedia of Greater Philadelphia. "Pharmaceutical Industry."
10. Smithsonian National Museum of American History. "Balm of America: Patent Medicine Collection."