Doctor's Review: Medicine on the Move

October 26, 2021

© Terence Mendoza /

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Popping pills

From inhalants and injections to tinctures and tonics, all have been employed over the eons by physicians to treat patients. Some medicinal methods of delivery were more successful than others — who could forget the opium clysters and porcupine-quill syringes of yesteryear? — but none has had the staying power of the lowly little pill.

These days, most patients and physicians associate the Pill (with a capital P) with the oral contraceptive. When it became available in the 1960s, the simple combo of hormones brought women from the delivery room to the boardroom and pharmaceutically fostered the feminist movement making it deserving of upper-case status. More recently, on the other end of the gender spectrum, proctologists and octogenarians could make a case for a little blue pill equally deserving of the honour. Interestingly, neither that pill — nor the Pill — were the first to be accorded rock-star status in the pharmaceutical pantheon. That distinction belongs to another.

Blue gold

The Blue Pill, a.k.a pilula hydrargyri, was a ubiquitous cure-all during the 19th century. First popularized among the sailors of the Royal Navy, it was taken as a remedy for constipation (courtesy of months at sea eating nothing but salted meat.) It was actually quite effective in this regard since it contained a third of mercury as well as several more innocuous ingredients like liquorice, marshmallow and glycerin. By land or by sea, Old World or New, everyone took the Blue Pill to cure what ailed them from the mildest toothache to the pains of childbirth and even depression.

Some medical historians even believe that Abraham Lincoln was a victim of too many of these pills because he was known for erratic behaviour and violent fits of rage — a common symptom of mercury poisoning. In 1861, his doctor advised that he stop taking them to treat his depression and, from that point onwards, Lincoln’s even temper prevailed. But what about before the 1800s? Had pills always been around? Not surprisingly, it was the ancient Egyptians who first started making them.

Chew on this

The Ebers Papyrus — dating from around 1550 BCE — contains hundreds of pharmaceutical concoctions. Most treatments were infusions in which herbs were soaked in water and then drunk as a tea. (The Assyrians were doing this as far back as 4000 BCE, when they added smashed seeds and plants to beer, creating some of the first medicine on record.) Others, such as the ones used to treat lung diseases like asthma, were inhalants in the form of plants and herbs placed on hot bricks whose smoke was then breathed in by the patient.

But it was the so-called katapotia — “something to be swallowed” — that are surely the forebears of modern pills. Plants and herbs believed to have medicinal properties were crushed and then mixed with honey, grease or even dough into tiny balls that were easier to swallow or chew. While the supposedly active ingredients included fragrant herbs like cinnamon, myrrh and saffron, then, as now, a spoonful of sugar helped the medicine go down. And, since the Papyrus is likely a compilation of even earlier medical material dating as far back as 3400 BCE, pills might have even been prescribed 55 centuries ago!

Amazingly, one of these early pills has been found intact. Dating to roughly 500 BCE, the Terra Sigillata is named for the dense red clay of the Mediterranean isle of Lemnos, which was mined one day a year amid much political and religious fanfare. Believed to have divine healing powers, it contained a wealth of adsorbent ingredients like aluminum, iron, silica, chalk and magnesium and remained a sought-after cure in Europe for everything through to the 19th century. The Terra Sigillata tablet is also famed for its inscription proving that pills were stamped to indicate identity and authenticity pretty much from the beginning.

Recently, a doctor’s kit was found among the cargo of a shipwrecked second-century BCE Greek warship off the Italian coast. Inside one tiny box, a handful of small discs — ancient pills — remained miraculously intact. DNA analysis revealed that they had been mixed with vinegar and contained substances like celery root and hibiscus.

Pliny’s pills

The term “pill” itself comes to us courtesy of Pliny the Elder (23-89 CE), the Roman naturalist whose encyclopaedic volumes recorded so much of the ancient civilization’s body of scientific knowledge. Among the treasures that have been unearthed from ancient Roman sites is a grooved pill-maker. At the time, clay was used as an excipient into which dried herbs and compounds were mashed. The clay was then pressed into the mould, allowed to dry, then popped out and divided into palatable portions.

But much of the medical knowledge contained within the Greek and Roman civilizations slipped into obscurity for centuries. As the Dark Ages approached, herbal infusions and pastes were the primary modes of medicinal delivery. Herbs were crushed by mortar and pestle and mixed with water, wine or honey into a paste that made them easier to imbibe. Plants and potions were experimented with for the various ills of the day, a process that varied widely across time and place. Each physician had his own preferred prescription.

Still, the process of pill-making slowly evolved out of these gloppy panaceas. Purity improved as extraction processes became more and more refined. Slimy vegetable gums and resins were used as coatings for the first crude pills, allowing them to be swallowed more easily. In order to standardize dosage and ease ingestion, many advances were made and records kept. By the 1600s, pill-making was an artful science, with makers garnering much respect and securing patents for their prized formulas.

The key to the development of effective pills came with the addition of excipients like sugar syrup and liquorice, which were used to bind dry medicines into sticky pastes that were then rolled by hand into tablets. They were easily swallowed and also tasted better than straight teas and bitter powders. In addition, the creation of pills allowed doctors to store, stockpile and distribute medicine far more conveniently than individually mixing medicine on the spot for each patient. The problem, however, was that these early pills required moisture to bind their ingredients together, which also reduced effectiveness and shelf life.

Art or science?

The mechanization of pill-making was still a few centuries away, so other methods were employed to create tablets of even size and dosage. Formulations and ratios were carefully recorded, with extra attention paid to the uniform distribution of medicine within each tablet. This was accomplished using so-called pill tiles. Herbs and chemicals would be compounded, an excipient added and then the whole thing would be rolled out into long ropes that would be placed upon the pill tile and cut into portions by following the numbered rulings or grid imprinted on the tile.

Many beautiful examples of these porcelain tiles still exist, some bearing elaborate painted representations of Apollo, the Greek god of healing, or other fanciful designs and pastoral scenes. By the end of the 1700s, however, pill tiles were most often found adorning the shops of apothecaries as more practical, less florid tablet templates became the standard. Numerous examples of 18th-century, delft blue pill tiles remain highly prized by collectors. (In case you’re thinking of starting your own, one shield-shaped pill tile dating to 1750 and bearing the insignia of the Worshipful Society of Apothecaries sold at a Christie’s auction for upwards of $17,000 last year!) But fear not: modern reproductions of these blue-and-white beauties are still available.

Through the 19th century, pill-making was revolutionized by the discovery of gelatin, which negated the need for wet excipients. Crank machines and other devices were created to allow for extremely uniform tablets, or pearls, as they were sometimes called. Physicians prided themselves on the beauty of their products, and while some learned the art of pill-making themselves, others hired apothecaries to create customized medicine for their patients.

Pretty useless

Pill coatings arguably became signs of status and wealth. While a patient of more modest means might be able to afford a simple shine on his or her pills — tablets were swirled in a container with varnishes and various other noxious coatings to achieve this effect — others wanted something a little flashier. Silvering pills became all the rage and soon gold leaf was applied as well.

Alas, so impervious was this pretty packaging that the pills themselves were often rendered useless, passing through the body virtually intact. (Then again, with iffy ingredients like mercury, strychnine and heroin, perhaps this was for the best). Eventually, common sense reigned and more inert coatings like chalk, wax and gelatine were used to give pills a smoother surface.

In 1843, the English painter and inventor William Brockedon (1787-1854) created a device into which powders could be poured and then hammered into hard pills with a mallet. Other new and improved pill-making machines quickly followed. Pill tiles and other early pill-cutting crank machines were still used well into the early 20th century, but industrial advances gradually phased them out.

Today, pills are created on massive mechanical assembly lines and hardened by pressures exceeding 50,000 pounds; a far cry from the hand-rolled globs of honey and myrrh described in the Ebers Papyrus, but the same basic idea nonetheless.

This article was accurate when it was published. Please confirm rates and details directly with the companies in question.


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