Origins: On the Pill

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As soon as man began to write, it seems, he was giving medical advice. Prescriptions and formulas are plentiful in the literature of ancient Mesopotamia. One cuneiform tablet suggests the following for an undisclosed ailment: “Pulverize the seed of the carpenter plant, the gum resin of the markasi plant, and thyme; dissolve in beer; let the man drink.”

Mesopotamian medicaments, however effective, are all liquid preparations. The Sumerians, Babylonians and Assyrians apparently knew nothing of what is for us the most common kind of dosage: the pill.

The earliest-known reference to pills comes in Egyptian medical papyri from the second millennium B.C. The most complete medical document is the so-called Ebers Papyrus, which was acquired in Luxor in 1869 by an American adventurer named Edwin Smith, who then sold it to the German Egyptologist Georg Ebers. In 1875 Ebers published a facsimile edition of the 110-page-long papyrus scroll, which dates to the ninth year of the reign of Pharaoh Amenophis I (1525–1504 B.C.).

The Ebers Papyrus describes 811 formulas for medicines used in ancient Egypt. Although the exact identity of the substances mentioned in the papyrus is often a matter of conjecture, we learn that the drugs were boiled and strained or pounded in a stone mortar. Remedies were often given as potions with beer, wine from grapes or dates, or milk. Sometimes they were formed into candy with honey, or baked into cakes with grease. But the ancient Egyptians also invented pills: “Malachite is ground fine, put into bread dough, made into three pills, and gulped down with sweet beer,” the Ebers Papyrus instructs.

It was the Greeks and Romans who popularized the pill, creating the tablets and lozenges we know today. The most common form of medication in ancient Greece was the katapotium, which means “something to be swallowed.” It initially referred to a soft preparation made by mixing medicinal substances and other ingredients in a semi-liquid form. However, this preparation was often so unpleasant to swallow that the Greeks created lozenges, which were taken with wine or water. Henceforth, katapotium referred to a pill.

Greek physicians didn’t prescribe aspirin and rest. They said, “Take a katapotium the size of a bean!” The first-century A.D. Roman writer Aulus Cornelius Celsus ordered katapotia the size of an almond or an Egyptian bean. Others prescribed katapotia the size of a dried pea. When a pill got very large, it was called a bolos, meaning “lump.” Of course, bolos is the ancestor of our “bolus,” which carries exactly the same meaning today: a large pill that is hard to swallow.

In his Natural History, 007Pliny the Elder (23–79 A.D.) refers to pills not as a katapotia but as pilulae (“little balls”), from which our word derives. Greco-Roman physicians widely prescribed a medication called Pilula Cochina, containing aloes and a strong purgative like colocynth (bitter apple).

One of the most popular medicines sold by drug vendors in Greece and Rome was hiera picra (holy bitters), for treating upset stomachs. According to tradition, it was first used in temples of Asclepius, the Greek god of medicine. Over the centuries, physicians altered and added ingredients to the formula, sometimes attaching their names to the compound.

The earliest recorded formula for hiera picra is that of Themison of Laodicea, in western Anatolia, a physician who practiced in Rome under Augustus (31 B.C.–14 A.D.). His recipe consists of aloes mixed with “mastic, saffron, Indian nard [probably spikenard], carpobalsamum and asarum [a wild ginger], of each an ounce.” Owing to the nauseous taste, the preparation was made into a bolus.

The physician Scribonius Largus (c. 1–50 A.D.) records that wealthy Romans were offering large sums of money for a bitters called Hiera Pachii. This medication had been developed (and kept secret) by a man named Pachius, the personal physician of the Roman emperor Tiberius (14–37 A.D.). The secret formula was subsequently discovered in a manuscript Pachius had dedicated to Tiberius, and the emperor promptly passed the formula on to Scribonius, with instructions that it should be published. This pill consisted of 14 herbs and became known as Hiera Scribonius Largus.

The famous physician Galen of Pergamum (c. 129–199 A.D.), who began as a gladiator and ended up as court physician to the Roman emperor Marcus Aurelius (161–180 A.D.), was a firm believer in the efficacy of hiera picra and invented his own formula: Hiera Galeni. It consisted of “Socotrine aloes 100 parts, cinnamon or canella, spikenard, xylobalsam, mastic, asarum, and saffron, six parts of each, and sufficient honey to make it into an electuary or pilula.”

The practice of “trademarking” medications is recorded as early as 500 B.C. Pills known as terra sigillata (sealed earth, not to be confused with the pottery of the same name) were prepared from clay found on the Mediterranean island of Lemnos. The clay was dug up, formed into discs and impressed with an identifying seal while still soft. The first seal used was an image of a goat, because the mixture contained Lemnos clay and goat’s blood. In time, the digging of Lemnos clay became associated with the worship of the goddess Diana that took place on the sixth of May; henceforth an image of Diana was used as the seal.

The first-century A.D. Greek physician Pedanius Dioscorides prescribed Lemnos earth as a treatment for dysentery, internal ulcers, hemorrhages, gonorrhea, fevers and kidney problems. While many of these powers were undoubtedly imaginary, terra sigillata has its counterparts even today in earthy compounds of magnesium, aluminum and silicon (like kaolin and bentonite, used to treat diarrhea).

The Romans used small rectangular slabs to make pills, and they often carried their pill slabs with them to distant parts of the Roman Empire. Two slabs in the Archaeological Museum at Namur, in Belgium, are made of black marble and measure about 4 inches by 3 inches. Greek and Roman medical authorities also frequently mention bronze or copper spatulas (above), which they used to roll the pill mass and cut it into pills. The spatula still serves as an essential tool of the modern pharmacist.

The Romans also employed the first pill machine. A 3-inch-long rectangular stone (above) from ancient Cyprus or Rhodes, and now in the British Museum, is carved with a number of grooves on one side. These grooves apparently served as pipes in which the pill mass was rolled and cut into pills.

Coating pills to make them palatable was practiced by the Arabs, who absorbed much Greco-Roman medical learning. One famous Arab physician, Abu Bakr Muhammad ibn Zakariya al-Razi (c. 850–925 A.D.), known in the west as Rhazes, recommended covering pills with a coating made from edible seeds. Another physician, Abu Ali al-Husayn ibn Abd Allah ibn Sina (980–1037), or Avicenna, suggested that pills be silvered or gilded—not simply to mask bad taste, but to 062employ the supposed medicinal effects of silver and gold.

The Arabs passed these techniques on to the West along with their rich knowledge of drugs. When the early 17th-century Parisian pharmacist Jean de Renou recommended that pills with a bitter taste should be gilded or coated with powdered spices, he was drawing directly on Arab learning. Well into the 19th century, pills were still being coated with gold and silver, though by this time pharmacists had begun to warn people that gilded pills often passed through the alimentary canal without being digested, owing to their metallic covering.

Today’s pharmaceutical industry produces millions of pills (mostly in the form of tablets and capsules) each day—a reminder of our immense debt to ancient Egypt, Greece and Rome.

As soon as man began to write, it seems, he was giving medical advice. Prescriptions and formulas are plentiful in the literature of ancient Mesopotamia. One cuneiform tablet suggests the following for an undisclosed ailment: “Pulverize the seed of the carpenter plant, the gum resin of the markasi plant, and thyme; dissolve in beer; let the man drink.” Mesopotamian medicaments, however effective, are all liquid preparations. The Sumerians, Babylonians and Assyrians apparently knew nothing of what is for us the most common kind of dosage: the pill. The earliest-known reference to pills comes in Egyptian medical papyri from the […]