For all the world's ills

This biography of aspirin is a good deal more digestible than the drug itself, and I enjoyed it greatly. There is a glorious irony in that morphine and aspirin, representing opioids and non-steroidal anti-inflammatory drugs (NSAIDs) respectively, have been with us for thousands of years, and that we have yet to produce better analgesics. We can tinker with rates of absorption and routes of administration and try to minimise side-effects, but we do not have a new class of analgesics. That really is the justification for a book about aspirin as the forerunner of a major class of analgesics. The subtitle could have been "the history of the Western world in a little pill".

The book is chronological, beginning in Egypt then journeying via Chipping Norton in the 18th century through to modern times. I enjoyed the digressionary journalistic style, which kept the snippets of arcane knowledge manageable. The Reverend Edward Stone is credited with making the link between willow bark and a treatment for lowering the fever of the ague. Stone was chaplain to the Cope family at Bruern who was involved in resolving a sexual harassment scandal at Wadham College, Oxford. The warden had to leave because he had allegedly molested a commoner. The legacy is a limerick that begins "There once was a warden of Wadham...".

The chemical synthesis of aspirin came more than 100 years later, and the German pharmaceutical company Bayer synthesised aspirin and heroin (diacetylmorphine) within a fortnight. The supremacy of these German companies, which began as dye manufacturers, was largely unopposed. The First World War, and then the Second, led to the fracturing of the German stranglehold on aspirin.

The legal decisions about the seizure and sale of enemy assets make for uneasy reading, with some eerie parallels to current debates about legal powers suborned by the executive. The influenza epidemic at the end of the First World War is well described, and the scale of the mortality is striking. Aspirin was in the right place at the right time, unopposed as the medicine to relieve the symptoms, and it looks as though this was the time that the Bayer proprietary name "aspirin" came into generic use.

Aspirin's role in world history was ensured in this era by Rasputin's smart decision to stop aspirin treatment of the Czar's haemophiliac son Alexei.

Aspirin's potential to increase bleeding was not then known.

The trade politics of aspirin in the 20th century are well described. Then, as now, the drug was available both over the counter and on prescription, and the battles between commerce and state control seem to be little changed. One legacy of the battle to control quackery was the split in control between the US Food and Drug Administration, making the "medical" decisions, and the Federal Trade Commission, where advertising control lay.

The last section describes aspirin's come-back as a low-dose preventer of heart attacks and strokes, after aspirin's use as a painkiller had diminished in many parts of the world, increasingly eclipsed by paracetamol and ibuprofen. This was not because aspirin did not work, but because paracetamol and ibuprofen relieved pain and fever with fewer side-effects.

Henry McQuay is professor of pain relief, Oxford University.