A complicated mixture called theriace is compounded of innumerable ingredients, although nature has provided many remedies each of which on its own would suffice. The 'Mithridatic antidote' contains fifty-four ingredients, no two substances having the same weight. The prescription for some is a sixtieth of a denarius1 -- which god, in the name of Truth, is responsible for this?
(Pliny the Elder, c.75 CE)2
A
medicine made from dozens of
drugs and prescribed for many
complaints, theriac was the
pharmacological shotgun of pre-modern
Western medicine. Mixtures of this name were used in
Europe for two thousand years; closely related theriacs were given to
Roman emperors, victims of the
Black Death, and 19th-century
hypochondriacs.
Though compounds of herbs are known from Mesopotamian sources, the direct ancestor of theriac was a blend supposedly mixed by Mithridates VI, the Pontic king famous in antiquity for his fear of poisoning. Besides acquiring immunities by dosing himself with poisons, Mithridates was said to have developed a recipe for a universal antidote, and cures of this type do appear among the Greeks shortly after his death in 63 BCE. Known first as "Mithridatic" remedies, they quickly came to be called by the existing name for an antidote, theriake (from the Greek for "wild beasts" or "poisonous reptiles"). Both names survived into later classical and medieval usage; "mithridatum" (and variants) retained the more specific sense of a cure for poison, "theriac" (and variants) came to be applied also to complex mixtures of drugs with wide applications (on which this writeup focuses) and to simpler homeopathic antidotes made from the flesh of snakes and other poisonous creatures.
Theriac spread with Greek medicine to Rome and throughout the Mediterranean. In the first century, Andromachus, a physician at Nero's court, gave his name to an improved recipe. In the second, Galen elaborated it further and fed it to Marcus Aurelius to ward against poison. Perhaps because of this prophylactic use, theriac came to be used as a treatment for illness and as a general tonic to maintain good health.
Theriac recipes were distinguished by their length, which was subject to the same kind of more-is-better inflation that has made it impossible to buy a frozen pizza with fewer than four cheeses. The earliest known version included 41 ingredients. Pliny mentions one with 54. Andromachus' had 64. Galen rounded it out to 77, and in later times variants climbed into triple digits. Most of the constituents were herbs, blended together into a powder that was then mixed into honey (one reason for the mixtures' success is probably that they can't have been unpleasant to take). The usual form of the drug remained into modern times a sort of dirty syrup -- theriac is the source of the modern word "treacle" (molasses having apparently replaced honey as the sweetener in medieval England).
Even in the classical world, theriac seems to have been little more than a mixture of all available drugs, dispensed (although this logic seems more medieval than Hippocratic or Galenic) in hopes that whatever the problem actually was, at least one of them would sort it out. What effect these compounds actually would have had is uncertain. They may have been effective against pain: Most preparations contained opium and alcohol, and at least one may have included cannabis. Most ingredients, however, would have done little and were anyway used (as Pliny complained) in such tiny quantities that it's difficult for anyone but a homeopath to believe they would have been efficacious.
But wel I woot thou doost myn herte to erme,
That I almoost have caught a cardynacle.
By corpus bones! but I have triacle,
Or elles a draughte of moyste and corny ale...
(Chaucer, Canterbury Tales, c.1390)3
The word and the idea, if not the recipes, survived the end of the classical world. Theriac appears (as tyriaca) in Saxon leech manuals of about 1000 CE. Islamic writers, including Avicenna (Ibn Sina), wrote on its preparation and use (as tiryaq). Chaucer used triacle4 for a cure, for a balm, for medicine in general, and as we would panacea, for a miraculous cure-all.
In medieval Europe, theriac was a tonic, the default cure, and the cure of last resort. The idea of a fantastically complicated potion with the power to cure any illness had obvious appeal for medieval scholars and doctors also keenly interested in alchemy and numerology. The preparation of theriac was a solemn and elaborate ritual, with cauldrons and slow cooking and lots of little bottles and exacting measurements. It was sometimes done in public, probably partly to assure customers of quality, but also because it was marvellous theatre and therefore excellent advertising.
In the 16th century, the recovered classical learning having attained more or less the status of scripture, attempts were made to prepare theriac according to Galen's recipe. Efforts were made to ensure quality, reduce substitutions, and restrict production to qualified professionals -- possibly to raise quality, probably to raise profits. Venetian theriac, because of the access the markets of that city gave to exotic ingredients, came to be the most famous preparation5.
And, without listening to the chemist, who was still venturing the hypothesis, "It is perhaps a salutary paroxysm," Canivet was about to administer some thériaque, when they heard the cracking of a whip...
(Flaubert, Madame Bovary, 1857)6
The demand for theriac survived into the era of modern medicine. As reverence for now-refuted classical writers like Galen dried up, preparations became more elaborate again, coming to include a hundred ingredients or more. In the pharmacy where 19th-century physiologist Claude Bernard was apprenticed as a young man, theriac was a sort of pharmaceutical hot dog prepared by mixing together all left-over, spoiled, and mis-mixed medicines and adding water7.
In the twentieth century, the successes of modern pharmacology pushed traditional preparations out of the mainstream of Western medicine. Universal education began to replace helpless credulity with healthful skepticism. Theriac was left on the fringes, and even there it began to be crowded out by the countless patent medicines that emerged out of the cocaine and snake oil industries in the exuberant days before drug regulation: The consumers of the modern mass market were thoroughly sold on the idea that new things were better.
Theriac did not, however, entirely die. The boom in herbal remedies -- arguably the patent medicines of the 21st century -- has both nurtured and responded to a recrudescent faith in traditional medicine. Though not available in any "authentic" form, "theriac" can now be bought alongside treatments and herbal simples from the exotic orient and Polynesia.
[Some company] has formulated a theriac that is thought to have the general therapeutic qualities of a Blood Tonic and Cleanser, restoring health and balance to the circulatory and immune systems. Paracelsus used a similar compound to strengthen the Heart, Liver and Kidneys, Today we recommend using Theriac BTC as a daily cleaner to remove environmental pollutants and food additives from the blood and related systems. $14.95 / fl. oz. (Internet ad, 2003)
1 Pliny seems to be using the denarius as a measure (i.e., 1/60th of the standard weight of the coin). He doesn't tell us enough to let us calculate a proportion, but the point is that some ingredients are used in ridiculously tiny amounts.
2 Natural History, 29.24. This translation is from John F. Healy's Penguin, p.266. The Latin text can be had at http://www.ukans.edu/history/index/europe/ancient_rome/L/Roman/Texts/Pliny_the_Elder/1*.html. There's also a very old English translation nearby.
3 Variant spellings in English include tyriac, tyriaca, tiriac, theriacle, triacle, tryakle, treakil, and many more.
4 Group 6, Introduction to the Pardoner's Tale.
5 "Venetian theriac" is also a name used for something otherwise called burnet-saxifrage root, for some reason.
6 Part III, Chapter 8. This translation from the Penguin of Geoffrey Wall except for "thériaque", which was translated as "antidote". (French text consulted at http://perso.wanadoo.fr/jb.guinot/pages/mortBovary.html).
7 This story from History of Medicine, Jacalyn Duffin, p.95, among other places.
Sources (incomplete):
Conrad et al., The Western Medical Tradition.
Jacalyn Duffin, History of Medicine.
Pliny, Natural History.
Oxford English Dictionary, Second Edition, 1989.
Oxford Classical Dictionary, Third Edition, 1996.
http://45.1911encyclopedia.org/P/PH/PHARMACY.htm
http://archopht.ama-assn.org/issues/v119n2/ffull/ebk0201-2.html
http://www.levity.com/alchemy/islam21.html
http://www.nlm.nih.gov/hmd/arabic/pharmaceutics44.html
http://www.google.ca/search?q=cache:syiOyEqa3d4C:www.chass.utoronto.ca/~ajones/cla203/galen.pdf+Galen+theriac&hl=en&ie=UTF-8
http://www.cmnh.org/dinoarch/1996Jun/msg00268.html
Avicenna's recipe: http://mapage.noos.fr/piling/art/art2_theria_composition.htm
The Canterbury Tales on-line: http://www.hti.umich.edu/cgi/c/cme/cme-idx?type=header&byte=15487761