Theriac – a Very Sovereign Remedy for the Plague – Galen c.166-170 A.D.

Theriac – the origin of our word treacle – is a complex medicine, some of the recipes for which sound like the witches’ incantation in Macbeth:

    Double, double toil and trouble;

    Fire burn and caldron bubble.

    Fillet of a fenny snake,

    In the caldron boil and bake…..

    One version required four vipers, 55 herbs, took 40 days to prepare and 12 years to mature.

    Other recipes are purely herbal and many contain opium and hemp, which may help to explain their popularity.

    It is thought to take its origins from the experiments of Mithridates of Pontus in the 2nd century B.C., to find an antidote to every poison. It is reported that he was so successful that when, captured by the Romans, he tried to poison himself, it proved impossible.

    Galen, also from what is now Turkey, was one of the greatest and most influential medical researchers and practitioners of antiquity. Marcus Aurelius, summoned him to be his medical attendant and it was perhaps through him that he took theriac daily as a preventative. Galen was in Rome at the time of the Antonine Plague and wrote extensively both on it and on the recipes for theriac and its uses.

    The following quotations from On Theriac to Piso, traditionally attributed to Galen, are from the excellent work by Robert Adam Leigh (see below). In it Galen discusses every aspect of theriac from how he learned about it to its preparation – including very detailed descriptions of how the vipers should dealt with – its prescription for a wide range of diseases and use, external as well as internal, recommended dosages and the best way to store it. The following are a few brief extracts:

I listened because the book was thoughtfully written by a certain man called Magnus, a man well versed in his art and practised not only in the experience of practical matters but also in theory, being well trained in accurately reasoning on the basis of the facts. At least he was thought to be the best of us doctors because of his excellence in these matters by the kings of those days, perhaps partly – it seems to me – because his nationality was ideally suited for him to learn the art of medicine. For he was of a Cretan family, and it seems likely that Crete, just as it bears many kinds of herbs, should also bear a man of this kind to be as it were a useful drug for mankind……

We know that the divine Marcus Aurelius who lately reigned righteously over us, because of the close and intelligent attention he paid to the constitution of his body used the drug greedily and as if it were a food. For because of him the drug became more widely known and the power of its action became clearer to men. For from the state of health which the emperor acquired the antidote gained increased faith in its power. But under that emperor only the fact of its use was known to the cognoscenti; but under our present great emperors its use has become general…….

I think Andromachus called theriac “Galene” in the verses set out above because out of the storm caused by illness it produces the calm, so to speak, of health in the body. For example it cures chronic headaches and vertigo and hardness of hearing and weakness of vision, and sometimes it strengthens the organ of taste……[A long list of diseases which theriac combats, especially rabies]

And in general theriac like a healing remedy gives precise help both when externally applied and when drunk to those bitten by mad dogs. And this same antidote has also shown itself in plague conditions to be the only one able to help those who drink it, no other form of help being constituted in such a way as to resist an evil of such magnitude. For plague like a kind of wild beast does not just kill a handful but spreads over entire cities and destroys them horribly, when some evil change happens to the air enabling it to kill, and because of the necessity to breathe men cannot escape the evil but draw the air into themselves like a poison through their mouths.

And so I commend the most wonderful Hippocrates because he treated that plague which spread among the Greeks from Ethiopia just by a change and alteration of air so as to change the nature of what people were breathing. So he ordered that fire should be lit across the whole city with the fire and stipulated that the material burnt consist not simply of wood but of the sweetest scented garlands and flowers and that they should drip on it the richest and most sweetly scented myrrh so that men should experience relief by breathing air that had been made clean in this way. I think that theriac as if it were itself a cleansing fire entirely protects those who drink it in advance from catching the disease during a plague epidemic and has the power to heal those who have already caught it altering and changing the harmful quality in the air they are breathing and preventing it from further damaging their constitution…..

And I especially advise you to take the antidote on your travels when you make a journey in winter when the air is cold. For it will be as it were a good garment for your innards and able to supply them with a good deal of warmth. And I know that it contributes to the intelligence and sharpness of the soul. For it causes the senses to work strongly and makes the mind clear of exhalations and causes it to reason more accurately. To put it briefly, it causes the body to be without ailment so that it is not destroyed by anything harmful. For the power of the drug is varied and so great that it produces such freedom from harm, especially when wild beasts are in the mixture. For they say that Mithridates that great warrior took, not theriac (which was not yet invented) but another complex antidote named after him, for it was called Mithridatium, and that the immunity it gave him meant he could not be killed while he was taking the drug…..

One of Many Lists of Ingredients for Theriac

Weigh out rose petals equal to 12 drachms and add Illyrian iris and mix in an equal amount of sweet-boughed black liquorice and the seeds of sweet French turnip. Add the juice of fragrant garlic germander, taking Assyrian balsam from within. Put in the same amount of cinnamon by weight and do not forget to add an equal amount of agaric and myrrh and sweet scented Saussurea Lappa and crocus grown in the Corycian cave; and add cassia and sweet scented Indian nard and camel-hay the wonder of the nomad Arabs and incense and black pepper and shoots of dittany and green horehound and rhubarb. Do not let cassidony be omitted, nor parsley. And let sweet scented mint and the piercing tear of Libyan terebinth, warm ginger and well branched cinquefoil two thirds of a drachma each be added and four drachma weights of hulwort. And bring boughs of dwarf pine and storax and bald money and grape bearing cinnamon and nard brought by a man of Galatia. Bring Lemnian red earth and spikenard from the Black Sea and seed of Cretan ground oak and the fine leaves of malabathron and cooked copper ore and gentian root and anise and the juice of hypocist and the fruit of balsam adding shining gum and fennel seed and cardamom from Ida. And add powdery cicely. And add and mix well in the dark sap of the milk thistle and an equal amount of shepherds purse and as much hypericum, and ajowan and one fourth as much of ferula persica and twice as much of the secretions of the Istrian beaver and a thin root of birthwort and seed of Athamanta Cretensis and dry asphalt which burns against the lairs of serpents. And mix an equal amount of all-heal juice with centaury adding an equal part of shining all-heal. Soften these in a mortar with a lot of wine as much as comes in liquid tears. Cut up small and mix up all the woody bits with Attic honey.

Theriac continued to be a staple medicine in the Byzantine world. According to the Golden Peaches of Samarkand, in 667, ambassadors from Constantinople presented the Tang Emperor with a supply of it. A contemporary Chinese pharmacologist commented on its usefulness and theriac continued to travel along the Silk Road.

Western Europe seems briefly to have lost the recipe. When King Alfred asked the Patriarch of Jerusalem for some effective medicines, he was sent theriac and a recipe for it was set down in The Leech Book of Bald, dated c.900.

The Islamic world inherited and preserved much of classical scientific knowledge and there are numerous works on theriac. The splendid Paris manuscript of the Kitab al-Diryaq, dated 1198, includes portraits of nine medical scholars, including Galen, with their recipes for theriac and 12 pages of illustrations of the ingredients.

By the 12th century, theriac was being manufactured at Venice – logically, as the city was a major terminus of the spice trade – and was widely exported; in England, theriac was known as Venice Treacle. There was, however, competition from other cities in Italy, as well as from Cairo and Constantinople.

The preparation of theriac was extremely complicated and its production came to be carefully controlled. If it failed to give the desired result, the physician could always blame it on some impurity or production failure, for which he was not responsible. A 13th century Arabic manuscript has a miniature showing a pharmacist being beaten up by a group of irate doctors.

Attempts to control the quality of spices and medicines are very old – as was the temptation to cut corners and adulterate expensive ingredients in order to maximise profits. In a market inspector’s handbook from 12th century Seville, the author, Ibn Abdun, describes some of the methods of cheating over, for example, saffron.

The Black Death, gave rise to a vast medical literature on the plague and theriac was considered the prime remedy and preventive. Production and exports soared, and attempts were made to introduce some sort of standards, especially at Venice, to preserve the reputation of the brand.

During the Great Plague in London in 1665-6, Directions for the Cure of the Plague, issued by the Royal College of Physicians discusses theriac – or Venice Treacle – as well as general recommendations for the preservation of health, some of which sound quite familiar today. J.P. Griffin has suggested, in an extremely interesting article (see below), that the whole process of establishing standards and purity in drug production began with the efforts to ensure that theriac was made strictly in accordance with the given formula.

Theriac continued to be made throughout the 19th century and in Naples up until the beginning of the 20th. I always thought the Friar’s Balsam of my childhood, now no longer manufactured, was a last faint echo of that very ancient remedy.

There is a large bibliography on Theriac – see the Wellcome Collection. One or two works mentioned are given below.

The quotations are taken from Galen on Theriac – On Theriac to Piso, Attributed to Galen Robert Adam Leigh PhD Thesis – U. of Exeter On-line: https://ore.exeter.ac.uk/repository/bitstream/handle/10871/13641/LeighR.pdf?sequence=1

Also: published by Brill, Leiden, 2015

Griffin, J. P. (2004). “Venetian treacle and the foundation of medicines regulation”. British Journal of Clinical Pharmacology. 58 (3): 317–325.

Fleming, Rebecca, Galen and the Plague

https://brill.com/view/book/edcoll/9789004383302/BP000018.xml

Kitab al-diryaq – some images available at:

https://www.facsimilefinder.com/articles/kitab-al-diryaq

Schafer, Edward H. (1985), The Golden Peaches of Samarkand: A Study of T’ang Exotics, University of California Press, 1963

Stone, Caroline, The Muhtasib, SAW Sept/Oct, 1977, pp.22-25

https://archive.aramcoworld.com/issue/197705/the.muhtasib.htm

N.B. In case I have infringed copyright on any occasion, please notify me and I will immediately delete the post.

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