Theriak / Theriac


Theriac or theriaca was a medical concoction made of opium, flesh of viper and a large number of other ingredients. It was originally invented as an antidote against snake venom and later used as a preventative panacea.

The word theriac comes from the Greek term theriaka, which refers to ancient bestiaries about dangerous beasts and their bites. Hence the antidote against animal bites came to be called a theriac, and it later became the English word treacle, via Middle English triacle.[1]

History

According to legends, the history of theriac begins with the king Mithridates VI of Pontus who experimented with poisons and antidotes on his prisoners. His numerous toxicity experiments eventually led him to declare that he had discovered an antidote for every venomous reptile and poisonous substance. He mixed all the effective antidotes into a single one, mithridatium or mithridate. Mithridate contained opium, myrrh, saffron, ginger, cinnamon and castor, along with some forty other ingredients.[2] When the Romans defeated him, his medical notes fell into their hands and Roman medici began to use them. Emperor Nero's physician Andromachus improved upon mithridatum by bringing the total number of ingredients to sixty four, including viper's flesh.[2] This medicine, called Theriaca andromachi or Venice treacle, was considered especially efficacious against snakebite although, in modern standards, the mixture would be an addictive tranquilliser. The Venice treacle became the traditional Theriac.

Greek physician Galen devoted a whole book Theriaké to theriac. One of his patients, Roman emperor Marcus Aurelius, took it on regular basis.

In 667, ambassadors from Rûm presented the emperor of Tang with a theriaca. The Chinese observed that it contained the gall of swine, was dark red in colour and the foreigners seemed to to respect it greatly. The Tang pharmacologist Su Kung noted down that it had proved its usefulness against "the hundred ailments". Whether this panacea contained the traditional ingredients such as opium, myrrh and hemp, is not known.[3]

Traditional theriac

The production of a proper theriac took months with all the collection and fermentation of herbs and other ingredients.It was supposed to be left to mature for years. It was also expensive and hence available only for the rich.
Patients would use theriac for bites but also as a preventative against any kind of poisoning and eventually against just about anything. It was used in salves and plasters or just eaten in chunks.
Theriaca andromachi or Venice Treacle contained 64 ingredients. In addition to viper flesh and opium, it included cinnamon, agarics and gum arabic. The ingredients were pulverised and reduced to an electuary with honey.
By the time of the Renaissance, the making of theriac had become an official ceremony, especially in Italy. Pharmacists sold it as late as 1884.
 Notes

   1. ^ Merriam-Webster's Online Dictionary: treacle. Merriam-Webster. Retrieved on 2007-02-28.
   2. ^ a b (Hodgson 2001, p. 18)
   3. ^ (Schafer 1985, p. 184)

References

    * Hodgson, Barbara (2001), In the Arms of Morpheus: The Tragic History of Morphine, Laudanum and Patent Medicines, Firefly Books, ISBN 1552975401.
    * Majno, Guido (1991), The Healing Hand: Man and Wound in the Ancient World, Harvard University Press, {{{PagesTag}}} 413-417, ISBN 0674383311.
    * Schafer, Edward H. (1985), The Golden Peaches of Samarkand: A Study of T'Ang Exotics, University of California Press, ISBN 0-520-05462-8
    * Griffin, J. P., Venetian treacle and the foundation of medicines regulation, British Journal of Clinical Pharmacology 58:3, Pages 317-325. doi:10.1111/j.1365-2125.2004.02147.x


   
[Theriac: medicine and antidote]
    [Article in French]
    Parojcic D, Stupar D, Mirica M.
    Histoire de la pharmacie et de l'ethique , Faculté de Pharmacie, Belgrade, Yougoslavia.

    Theriac was an ancient multi-ingredient preparation; originating as a cure for the bites of serpents, mad dogs and wild beasts, it later became an antidote to all known poisons. The name theriac (treacle), (Greek theriake, Latin theriaca, French thériaque) was derived from the Greek for wild beast - theriakos. The first formula was created by Mithridates Vl, King of Pontus, a skillful ruler but a monster of cruelty, who, living in such a fear of being poisoned, took a great interest in toxicology. In the 1st century AD, Nero's personal physician Andromachus improved the formula of Antidotum Mithridatium by adding flesh of vipers, which was commonly believed to be the best antidote against snakebite, and by increasing the proportion of opium. It became known as Theriac of Andromachus, and contained 64 ingredients including various minerals, herbals, poisons and animal flesh and blood, all combined with honey in the form of electuarium. Later it became the cure-all medicine which, accumulating all the simples into one form, was supposed to be a universal panacea against all diseases. In the Middle Ages this famous electuarium become a patent medicine and entered official dispensaries and pharmacopoeias. The most famous and expensive Theriac in Europe was that of Venice. It was not until the l8th century that it was excluded from medical use.PMID: 15125416 [PubMed - indexed for MEDLINE]

Br J Clin Pharmacol. 2004 Sep;58(3):317-25.
    Venetian treacle and the foundation of medicines regulation.
    Griffin JP.
    Faculty of Pharmaceutical Medicine, Royal College of Physicians of London, 1 St Andrews Place, London NW1 4LB, UK. JQmans5@aol.com

    Mithridatium and the related product Theriac were both regarded from the time of their original formulations in the 2nd Century BC and the 1st Century AD respectively, until the mid 18th Century as universal panaceas. Any failure of these products to achieve the desired therapeutic result was attributed to defective composition or manufacture. As a result measures were introduced to ensure the quality of ingredients used in these products composition, the establishment of standard formulations and assurance of the competence of the manufacturer. Manufacture frequently was required to take place in public. Doubts about the efficacy of these panaceas arose in the mid 18th century and concerns of the adverse nature of interactions between the numerous ingredients surfaced in Heberden's treatise of 1745, as result of which these products disappeared from Editions of The London Pharmacopoeia after 1746. Subsequently, arising from these concerns for safety and efficacy, a call was made in 1799 for the establishment of a Public Committee of eminent physicians to scrutinise all new products prior to their launch to an gullible public. The concepts developed in the history of Mithridatium form the basis of modern medicines regulation.



Bartisch on Theriac
Donald L. Blanchard, MD
Arch Ophthalmol. 2001;119:1360-1363.

George Bartisch is best known as the German ophthalmologist who wrote the mammoth textbook Ophthalmodouleia, printed in 1583. He wrote several other books, most of which were never published. One that he self-published is on Venice Theriac of Andromachus. Common theriac has a long history in medicine from just after Hippocrates. It initially was used for venomous snake bites but later was used for poisonings too. By Bartisch's time it was considered a nearly universal cure-all. In the book, a multitude of ophthalmic and general diseases are listed and then the dose of Theriac is given. Bartisch warned against the many inferior types of theriac available through unscrupulous traveling salespeople. He offered the superior Venice Theriac for sale, compounded by himself in Dresden, Germany, where he resided.
George Bartisch, the famous German ophthalmologist, published a booklet in 1602 on the Venice Theriac of Andromachus,1-2 which was a then well-known cure-all. His reputation now rests on his book Ophthalmodouleia, printed in 1583,3 which was the first comprehensive ophthalmology text in a modern language. It was written in a dialect of Early New High German and was directed toward the layman and surgeons. This is in distinction to the then standard works in Greek, Arabic, or Latin, which could only be read by physicians who had medical training. This training, however, did not generally include ophthalmic surgery. The surgical sections were then meant to improve the level of care provided by ophthalmologists to people with eye afflictions. Detailed prescriptions were included to allow the layman to prepare the mostly herbal remedies for those occasions when a trained person was not available.

Although the treatments he recommended are long out of favor, the essays he wrote that begin each disease section are commonly quoted in the historical introduction to modern papers. The color illustrations, especially of Bartisch preparing to couch a cataract or a strabismus patient with a full head mask to straighten his eyes, often will be shown at the beginning of a talk on new ophthalmic surgical procedures.

Bartisch was born in Königsbrück, Germany, in 1535.4 Because of poor finances he was unable to attend medical school and instead apprenticed himself to learn ophthalmology and bladder stone surgery. He was proud and pleased with his chosen profession and frequently felt called upon in his writings to clarify the difference between trained ophthalmic surgeons and other untrained practitioners. Treacle salesmen were especially singled out for his contempt.

Treacle as a loose synonym for theriac has an etymological history beginning with the Greek therion (a wild beast) and the Greek theriake (antidote for a beast attack, especially snake bites). In Latin this became theriaca (the medicine often made with viper meat) with the Vulgar Latin triacula and the diminutive theriacula. In Middle English it was triacle, and finally in English it became treacle. Today, treacle also refers to molasses, and in Bartisch's day these products were often sweetened. Here, for clarity, Theriac will refer to Venice Theriac of Andromachus, which Bartisch was mostly concerned with. The noncapitalized theriac will refer to the host of similar compounds then being sold for the same purposes. However, they were much simpler in their preparation. Bartisch believed that a few of these had value. Treacle will refer in a derogatory way to the bogus products Bartisch mentions with intense scorn.

Treacle salesmen were discussed with a warning to unwary patients. People were to watch out especially when the salesman had long hair. Such people were often posing as foreigners who brought Theriac with them from Venice, when actually they had never been more than 30 miles from their hometown.5 Speaking about how an ethical ophthalmologist practices, Bartisch says he "should have the manner and habit that he does not praise himself or think that he alone can do it or he is the first and foremost and the best." The ostentatious garb and fake splendor of treacle salesmen and other practitioners with their many horses and servants do not meet this ethical standard. "Many people not only are disgracefully and easily cheated (by the treacle salesmen) and pulled in, but also the people overestimate them. Finally the people are ruined and die." Treacle salesmen contributed to the misery of the masses.

Throughout much of Bartisch's career he was an itinerant ophthalmologist with Dresden, Germany, as his home base. He would follow a certain route to be in town during a fair. Early in his career he was assigned a position on the outskirts of the market with the "former henchmen, old hags, ruined shopkeepers, rat catchers, and treacle salesmen" who were offering the same services. As his fame grew and especially after the publication of Ophthalmodouleia, Bartisch achieved a privileged position at the markets when he traveled and as the court ophthalmologist at home in Dresden. He had dedicated the work to August, the Elector of Saxony, and presented him with a copy of the book, hand colored by Bartisch himself. This did much to win favor in court. At that point he had the proper licenses and passports as well as a wealth of testimonials and the Saxony seal of good will. This enabled him to get a stall at the various markets. He was then spared the embarrassment of being compared with treacle salesmen, who had the habit of quizzing the locals about residents with vision problems, then visiting those homes claiming to have been sent by the lord of the manor to care for his unfortunate peasants. The peasants paid the fee though in advance.6-8

The book on Theriac was published at a more sedate time in the life of Bartisch. In Dresden he was the court ophthalmologist, and he received a regular stipend for this. He had trained his son, Tobias, in ophthalmology and the art of surgery, and they were in practice together. His fame had spread so far by this time that there is even a record of the Queen of Denmark writing to ask about the magnificent reports of his great skill.

Bartisch was a prolific writer, yet getting financial backing for his books remained a problem. Ophthalmodouleia sold very well and earned him vast respect, but it was self-published in the first edition. Although few of them survive, he is said to have written at least 16 other books on topics such as hernias, anatomy, and dreams. At least 2 of the books were in verse.9 Kunstbuch, which is about urinary tract stones, was unpublished in his lifetime due to the lack of a publisher. The Theriac book, also self-published, was probably issued in a very limited edition and is extremely scarce now, with only one original copy available in a US library.

Bartisch died in 1606, but many of the skills and medicines he described in his books lived on and were still believed to be valid hundreds of years after his death. Today, he remains as one of the major figures in ophthalmology.



HISTORY OF THERIAC

As a popular medicine, theriac has an approximately 2000-year history, beginning as a cure for venomous bites.10-11 Nicander,12 in the second century BC, wrote a long poem about theriac addressed to the King of Pergamum, who was notorious for testing remedies on prisoners and servants.

In the first century AD, Andromachus took many of the ingredients of mithridatium (a popular antidote for poison) and the earlier theriac compounds and importantly included vipers.13 He called his medicine "Tranquility." It was believed to be effective against snake and other venomous bites and stings of insects. It was a general antidote against poisons and pollutions, and it was used for all manner of general ailments as a curative and preventive. Andromachus wrote his formula in a poem dedicated to Nero, who seemingly was most interested in its properties as an antidote against poisons.

In the next century, Galen (131-201 AD) wrote about various theriac compounds, but his favorite was the Theriac of Andromachus.13 This preparation was compounded by Galen for the Emperor, Marcus Aurelius, who took a daily dose of it to protect against poisons and to aid in ensuring good general health. After Galen, medicine entered a time of minimal advancement, and with his blessing the Theriac of Andromachus maintained a privileged status as the preferred theriac. The basic formula as it existed through the centuries was fairly stable, consisting of vipers, opium, wine, honey, cinnamon, and about 60 herbs.13-15

In the 12th century, Venice had become known as having a premier quality of Andromachus' Theriac. A religious and medical festival was held there each year for the preparation of the authentic Theriac. The compound, once prepared, was a rather soupy mix, and it was stored in a cool, dry place to mature. Seven years was a common time to wait until using Theriac.

In Bartisch's time, Nuremburg, Germany, routinely had a similar 2-month festival in honor of Theriac conducted by the government. Queen Elizabeth I was a regular taker of Theriac, primarily as a prophylaxis against poisoning. Also, in the 1600s, the King of France had his apothecaries breed vipers so that Theriac could be made locally.10

In the early 1700s, the Pharmacopoeia Officinalis of England15 called the Theriac of Andromachus a "grand medicine"; however, this honored place for Theriac and the whole class of drugs referred to as theriac all came to a halt after the publication of Antitheriaka by W. Heberden in 1745.16 His attack on theriac as an unfounded polypharmacy of conflicting ingredients was very effective, and by the close of that century Theriac was taken off most formularies, although it survived here and there in India and a few European cities.



BARTISCH ON THERIAC
Bartisch's 44-page booklet about Theriac is a simple document.1 His picture is the only illustration (Figure 1). This frontispiece shows an elderly man handsomely gotten up. Being a resident inhabitant of Dresden with people coming to him was clearly preferable to being on the road. There are no direct Greek quotes, although Latin terms are used. The history of Theriac is explored, but the book lacks extensive discussions and histories of diseases. The introduction directs a venomous attack at treacle salesmen. He bemoans the gullibility of ophthalmic and general medical patients, particularly simple farmers intent on saving money. Bartisch is clearly exasperated with the situation but ultimately blames the simple peasants too for their unthinking false thrift. However, he realizes that he will not change people and concludes with a proverb: "Why feed a cow nutmeg when it will fatten up on oat straw."
George Bartisch.
Bartisch does not set a price for his Theriac but says that the price of treatment depended on the prosperity of the patient. A full can of a bogus product obtainable from treacle salesmen at the market was 3 or 4 pfennigs. In his tract on theriac in 1596, J. Graman, a German physician, offered a quality theriac at a much higher cost, with about 4 doses of his theriac selling for 1 German thaler.17 It is difficult to be precise about local economies, but a cow could be purchased at about this same time in Germany for 5 thaler.18

The main part of the book is a listing of ophthalmic and general diseases followed by the dose and mode of administration of Theriac, which was generally given with wine but could be taken dry. A patient might, in addition, be bled or take the baths or a sweating treatment, but taking Theriac was central in the way to a cure. He does not give the formula for Theriac. The multitude of difficult-to-obtain ingredients made it impossible for a layman to compound this medicine, unlike most of the simpler prescriptions in Ophthalmodouleia. The way for someone in Dresden to be sure of getting the bona fide product was to get it from Bartisch. On the other hand, he gives away treacle salesmen's secrets by listing the formulas for some of the bogus preparations.

In Ophthalmodouleia, he identified himself only as a surgeon who performed eye surgery and operated on urinary tract stones. In the Theriac book he described himself in what may be a grammatical laxity as a physician as well. This would, however, explain the expansion of his practice of ophthalmology to include the whole host of medical diseases he lists.

Bartisch believed that people were sinful children of Adam and Eve deserving punishment in the form of being subject to horrible diseases, including blindness. God was merciful, however, and allowed Theriac to be available to physicians to aid the tribulations of humankind. "People particularly should use this noble Theriac . . . , who with age are polluted with much phlegmatic, cold, spoiled and melancholic, old, misplaced, fouled humors."

In Bartisch's Theriac text, more than 70 major categories of treatable diseases are listed. Venomous bites and poisons of all kinds did particularly well with Theriac treatment. General ailments also were to be treated, such as problems of aging, headaches, strokes, epilepsy, memory difficulties, and various organ failure diseases.

In the ophthalmology sections he describes the same melancholic, cold, foul humors as also causing vision problems, particularly with age. Dizziness was commonly associated with a visual sensation of spinning. This was treated with Theriac in creeping thyme and wild marjoram water. Dark, cloudy, weak, and dim vision problems were all linked together as age related and were treated with a pea-sized dose of dry Theriac eaten each evening. Blindness could come from a rising up of evil vapors from the stomach. A polluted head and deafness also went along with this problem and were also treated with a daily dose of dry Theriac.

In Ophthalmodouleia, he does not specifically use Venice Theriac of Andromachus, but he does list several other theriacs of the finest quality as useful for the ophthalmic disease conditions just mentioned. In both books he is revealed as a caring doctor who wishes that quality medical care were more standard. Although he did not have a classical education, his medical knowledge was broad, and like others in his day, his physiology was based on Galen's traditional explanations. Bartisch firmly believed in the usefulness of his treatments and was humble in his status as a mere vehicle through which God might bring relief to the sufferings of humankind.

AUTHOR INFORMATION
Accepted for publication March 8, 2001.
Corresponding author: Donald L. Blanchard, MD, 10907 SE Azar Dr, Portland, OR 97266 (e-mail: dblanc@teleport.com).
Dr Blanchard is a clinical instructor at Oregon Health Science University, Portland.

REFERENCES

1. Bartisch G. Warhafftige, eigentliche und ausführliche Beschreibung . . . des grossen Theriacks. 1602.
2. Bartisch G. Theriac. Blanchard D, trans. Portland, Ore: Blanchard's Books; 2000.
3. Bartisch G. Ophthalmodouleia. Dresden, Germany: printed by M. Stöckel; 1583.
4. Bartisch G. Ophthalmodouleia. Blanchard D, trans. Oostende, Belgium: Wayenborgh; 1996.
5. Bartisch G. Kunstbuch: The Art of Lithotomy-1575. Blanchard D, trans. Oostende, Belgium: JP Wayenborgh. In press.
6. Hirschberg J. History of Ophthalmology. Vol 2. Blodi F, trans. Bonn, Germany: Wayenborgh; 1985.
7. Wood C, ed. American Encyclopedia of Ophthalmology. Vol 2. Chicago, Ill: Cleveland Press; 1913.
8. Tower P. Notes on the life and work of George Bartisch. Arch Ophthalmol. 1956;56:57ff.
9. Bartisch G. Kunstbuch. Mankiewicz O, ed. Berlin, Germany: Oscar Coblentz; 1904.
10. Watson G. Theriac and Mithridatium. London, England: Welcome Historical Medical Library; 1966.
11. LaWall C. Four Thousand Years of Pharmacy. Philadelphia, Pa: Lippincott; 1927.
12. Nicander A. Hellenistic Treatise on Poisonous Animals (The "Theriaca" of Nicander of Colophon). Knoefel P, Covi M, trans. Wales: Mellen Press; 1991.
13. Galen. Opera Omnia. Vol 14. Kühn C, ed. Hildesheim, Germany: Olms; 1965.
14. Pliny. The Natural History of Pliny. Bostock J, Riley H, trans. London, England: Bohn; 1856.
15. Quincy J. Pharmacopoeia Officinalis and Extemporanea. 8th ed. London, England: Osborn; 1730.
16. Heberden W. Antitheriaka. London, England; 1745.
17. Graman J. Wafhafftige Ursachen . . . Theriac. Printed by Beck; 1596.
18. Grimm J, Grimm W. Deutsches Wörterbuch. Vol 21. Leipzig, Germany: Hirzel; 1854.
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