Patent medicines, proprietary medicines sold without prescription, are of historical interest for their role in the development of the pharmaceutical industry and for their notably dubious reputation. They provided a major source of self-medication, although they may have had physiological effects that were poorly understood by the consumer. Because specific preparations were not patented, the formulation of a patent medicine could be changed at any time. During the first half of the 20th century, as regulatory oversight developed, patent medicines transitioned from essentially unregulated products to ones that were accountable for their contents and medical effectiveness. Two early synthetic analgesic/antipyretic drugs that were often used in patent medicines are acetanilide and phenacetin (acetphenetidin), which are both predecessors of acetaminophen. Acetanilide in particular is known for its side-effect of cyanosis due to poor blood oxygenation. Bromo-Seltzer and Antikamnia were two popular analgesic-containing patent medicines used widely from the 1890s through the mid-20th century. In this study, the contents of each were tracked over time using a combination of vintage package labeling and contemporary published analyses. Both products originally used acetanilide as the major analgesic. After passage of the 1906 Pure Food and Drug Act, the acetanilide in Antikamnia was replaced with phenacetin, which was used until the product was discontinued in the 1930s. The acetanilide in Bromo-Seltzer was also replaced with phenacetin after 1906, but within a few years acetanilide returned as a major ingredient. Bromo-Seltzer continued to contain acetanilide well into the 1970s, suggesting that this drug may have had a more significant role in self-medication than is generally recognized. Knowledge about the changing contents of products such as Antikamnia and Bromo-Seltzer offers a window into the health of past generations and insight into the evolution of old-time patent medicines into the over-the-counter medicines of today.

Analgesic contents of patent medicines of the early 20th century: Bromo-Seltzer and Antikamnia

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