In 1926, the modern pharmaceutical market of mass-manufactured, branded tablets did not exist. Instead, physicians wrote prescriptions for active chemical compounds, botanical extracts, and tinctures that pharmacists compounded by hand.
According to historical prescription audits—most notably the nationwide Charters Survey of 1926 (later compiled in the American Pharmaceutical Association’s Prescription Ingredient Survey)—the 10 most frequently prescribed active medications (excluding compounding vehicles like distilled water and simple syrup) were:
- Codeine (Sulfate / Phosphate): The single most prescribed active therapeutic ingredient in the country. By 1926, codeine had largely displaced morphine for routine outpatient use as a cough suppressant and mild-to-moderate analgesic.
- Acetylsalicylic Acid (Aspirin): First synthesized by Bayer and out of patent by the 1920s, aspirin was the dominant non-narcotic pain reliever and antipyretic for colds, influenza, headaches, and rheumatism.
- Sodium Bicarbonate: Prescribed in massive quantities both as a stand-alone antacid for dyspepsia and indigestion, and as an alkalizing buffering agent in compounded powders and liquid mixtures.
- Phenobarbital (Luminal) / Barbital (Veronal): Barbiturates became the go-to class of sedative-hypnotics and anticonvulsants in the 1920s, replacing harsher 19th-century sedatives like chloral hydrate.
- Quinine (Sulfate / Hydrochloride): The standard frontline treatment for malaria (which was still endemic across parts of the American South) and frequently prescribed in low doses as a bitter “tonic” and fever reducer.
- Morphine (Sulfate): Reserved for severe, acute pain, surgical recovery, and palliative care. Although strictly regulated after the 1914 Harrison Narcotics Tax Act, it remained an indispensable hospital and clinical analgesic.
- Strychnine (Sulfate): In the 1920s, strychnine was routinely prescribed in micro-doses as a central nervous system stimulant, cardiac tonic, and appetite builder.
- Atropine (or Belladonna Extract): An anticholinergic alkaloid derived from Atropa belladonna, widely prescribed for gastrointestinal cramping, respiratory congestion, asthma, and ophthalmological exams.
- Calomel (Mercurous Chloride): A 19th-century cathartic mainstay that, while declining significantly by 1926 due to toxicity concerns, was still frequently ordered as a heavy purgative and “cleanser of the bowels”.
- Digitalis (Foxglove extract): The cornerstone cardiac medication of the era, prescribed as a tincture, powder, or infusion to strengthen heart contractions in patients suffering from congestive heart failure (then referred to as “dropsy”).
