The art of medicine

The theriac in antiquity In Greek mythology,

Panacea, the goddess of healing was said to have a potion that healed every sickness. The   search for the cure-all remedy would continue throughout antiquity as physicians and healers tried out various cures in the regular care of their patients, especially in desperate situations. In the ancient world, poisonings were fairly common and the pursuit of a compound that was capable of protecting a person against any kind of toxin led to the popularity of what was thought to be a universal antidote: the theriac. The name theriac comes from the Greek term theria, which refers to wild beasts, and it was given to a preparation that served initially as an antidote and later as an all-purpose drug. According to Pliny the Elder (23–79 AD) and Galen of Pergamon (131–201 AD), one of the earliest formulations for a theriac against the bites of venomous animals was inscribed on a stone in the Temple of Asclepios on the island of Kos, and it contained thyme, opoponax (sweet myrrh), aniseed, fennel, and parsley. Another early reference to  theriacs can be found in the didactic poems Theriaca et Alexipharmaca, from the second century BC, by the Greek grammatician, poet, and physician Nicander of Colophon who described a variety of poisons from animal bites and their antidotes. The idea of a theriac seems to have gained greater prominence during the reign of Mithridates VI (132–63 BC), King of Pontus in Asia Minor. Mithridates VI lived in a constant fear of being poisoned and not only tested poisonous substances on criminals and slaves but also regularly ingested poisons and their antidotes himself. His personal physician Crateuas concocted an antidote known as Mithridatum, which contained about 40 ingredients and was thought to be protect against scorpions, vipers, sea-slugs, as well as other toxins. Mithridates appears to have become so accustomed to various poisons that he attempted suicide by self-poisoning when he was captured by Pompey. Yet as Dio Cassius wrote “the poison, although deadly, did not prevail over him, since he had inured his constitution to it, taking precautionary antidotes in large doses every day”. Some histories describe that having failed in this attempt, Mithridates ordered one of his soldiers to kill him with a sword. Among the papers of the defeated king, Pompey found the receipt for Mithridatum and translated it into Latin.


Different kinds of theriacs were subsequently produced in antiquity but the most celebrated was perhaps the one invented by Andromachus, physician to the Roman Emperor Nero, in the first century AD. Andromachus came from the island of Crete where “botanical men” in the service of the Emperor collected herbs and placed them in knitted vases, which were sent not only to Rome but also to other nations. Andromachus’ vast knowledge of botany helped him “to provide the mankind with the necessary medicines”. He claimed that his formula for his Galeni Theriaca (tranquillity theriac) was an improvement on that of Mithridates because it contained 64 ingredients and was enriched with the flesh of viper with a much greater quantity of opium. According to Andromachus, his theriac would not only counteract all poisons and bites of venomous animals, but would also diminish pain, weakness of the stomach, and help treat asthma, colic, dropsy, inflammation, and even the plague. Indeed, Andromachus’ theriac raised him to the dignity of Archiatrus (chief-physician) and the preparation enjoyed a great reputation for centuries. In the next century, the Greek physician Galen formulated a theriac that would, he intended, eclipse all others in its fame and popularity. Moreover, he experimented with his theriac, intent on proving its therapeutic effect. Galen is, of course, Wellcome Library, London one of the leading figures in classical medicine. He wrote a great number of  treatises on medical and philosophical  subjects and his doctrines dominated medical thought  until the 16th century. Born in Pergamum, part of Asia  Minor, Galen’s father Nicon, a wealthy architect, oversaw his education. Initially, Galen studied medicine in his home city, then in Corinth, and finally in Alexandria. Returning  to Pergamum, he was appointed as a city physician to the  School of Gladiators but gained such a reputation that he  soon became the court physician of the Roman Emperors Marcus Aurelius and Lucius Verus.
Following Hippocrates’ humoural theory, Galen believed  that the four humours of the body (phlegm, blood, black  bile, and yellow bile) were responsible for health or illness.
Going further, he classified all personalities into four types:
phlegmatic, sanguine, choleric, and melancholic. Imbalances  in these humours would lead to the disease and could be  corrected not only by adding herbal extracts of similar origin
but also other extracts with opposite properties. Galen  believed more than one medicine has to be administrated  in order to have a therapeutical effect, and favoured mixing
several agents to optimise their absorption. In the royal  court, Galen prepared his theriac and wrote about various  theriac compounds in his books De Antidotis I, De Antidotis II,
and De Theriaca ad Pisonem. The basic formula consisted of  viper’s flesh, opium, honey, wine, cinnamon, and more than  70 ingredients. The final product was supposed to mature for  years and was administrated orally as a potion or topically  in plasters. Galen claimed that his theriac drew out poisons  like a cupping glass and could divide the tissue of an abscess  more quickly than a scalpel. The preparation was taken daily by the Emperor Marcus Aurelius to protect against poisons  and to aid in ensuring good general health.
But Galen did not just administer his theriac, he also writes about experimenting with it on animals. In De theriaca ad  Pisonem he describes how he took roosters and divided
them in two groups: in one group he gave the theriac and  in the other group he did not. Then he brought both groups  into contact with snakes; Galen observed that the roosters
who had not been given the theriac died immediately after  being bitten, whereas those who has been given the theriac  survived. Moreover, he points out that this experiment could  be used in cases where someone wants to make sure whether  a theriac is in its natural form or has been adulterated.
Alongside this work, Galen also wrote about the effect  of his theriac on individual patients. In one passage in De  Theriaca ad Pisonem, his gives an illuminating account of  treating jaundice caused by snake bite with theriac.
One of the slaves of the Emperor whose duty it was to drive  away snakes, having been bitten, took for some time draughts of ordinary medicines, but as his skin changed so as
to assume the colour of a leek, he came to me and narrated  his accident; after having drunk theriac he recovered quickly  his natural colour. Physicians seek to find out if there are  signs peculiar to poisoning, because they often see, without  the administration of any deadly poison, that the body  presents a corruption of the humours similar to that which is  produced by poisons; it is not at all surprising, therefore, that  there sometimes supervenes a change in the humours, so  that the whole body is affected with jaundice.
Galen called his preparation Theriac of Andromachus and  for as long as Galenic medicine held sway, so did the appeal  of the theriac—not just as an antidote for snake bites but
gradually it came to be regarded as a universal cure-all.
Stored in ornate porcelain jars, often illustrated with scenes  from the life of Mithridate, it survived into medieval Europe  in the trade that developed in theriacs, most notably in
Italy, which became known as the Venice Treacle, an official  preparation that carried the republic’s seal. Its legacy is even apparent in French and German pharmacopeias of the 19th  century. Whether as a universal panacea or just an addictive  preparation thanks to opium, the theriac’s history seems to  have lasted more than 2000 years.

Demetrios Karaberopoulos, *Marianna Karamanou,George Androutsos
History of Medicine Department, Medical School, University of  Athens, 145 64 Athens, Greece

Further reading:
1. Galen. De Theriaca ad Pisonem.In: Opera omnia, ed. Kühn CG,XIV, Hildesheim: Olms, 1965
2. Mattern SP. Galen and the  Rhetoric of Healing. Baltimore:
The Johns Hopkins University  Press, 2008
3. Porter R., Teish M. Drugs and  Narcotics in History. Cambridge:
Cambridge University Press, 1995
4. Watson G. Theriac and  Mithridatum: A study in  therapeutics. London: Wellcome
Historical  Medical Library, 1966
5. Thompson CJS. The mystery  and art of the apothecary.
London: John Lane, The Bodley  Hend, Ltd., 1929


About sooteris kyritsis

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