THERIAC
If you are looking for a super-remedy that cures everything, reach for theriac, if you can find it. Theriac is one of the historical all-time greats of pharmaceutical success, used by emperors, kings, and anyone else who could afford it. Though it’s use has given way to the advances in pharmaceutical sciences, its history holds lessons for today.
The origins of the theriac recipe are obscure. The story allegedly begins with Mithridates VI, king of Pontus, a large kingdom surrounding most of the eastern Black Sea. He believed that his father, Mithridates V, was poisoned (120 B.C.) and, in an attempt to head off a similar fate, he regularly took small doses of poisonous substances to build resistance. After Mithridates VI’s death, the ingredients he was taking were incorporated into a poison-preventive remedy known as Mithridatium that soon became a preventive for a number of illnesses unrelated to poisoning. Later, Andromachus, physician to Emperor Nero, modified the formula, most notably by substituting viper’s flesh for that of the lizard, in order to prevent poisoning by venomous bites. He also added opium and several other ingredients, including Lemnian earth (a red soil from the island of Lemnos), roasted copper, bitumen, additional herbal plants, and squills (a medicinal plant). The new formula eventually acquired the name “theriac,” derived from the Greek theriake, an adjective signifying “of a wild or venomous animal.”
Galen used both theriac and Mithridatium and wrote that he had tried theriac on roosters “with creeping poisonous beasts among
Galen (Wellcome Library)
them” and found it successful. In addition to anti-poison and antivenom effects, Galen modified theriac doses to take advantage of ingredients known to heat, dry, moisten, or cool the humors, according to the Galenic scheme. He used it for malaria with mixed results.
The use of theriac survived the fall of the Roman Empire. After the Islamic takeover of territory east of Europe, recommendations for theriac surfaced in writings of Rhazes, Avicenna, and others and in some form was in use in medieval Europe. As the Renaissance dawned, the western world relearned theriac’s formula (or formulas, as by then pharmacists puzzled over the identity of certain ingredients or could not obtain them). Different formulas contained 40 to 60 ingredients, though numerous simplified versions of “theriac” flooded the market, prompting many cities to establish days when an official version was manufactured. Physicians, pharmacists, and government dignitaries supervised the process publicly, and certified it as genuine. 
Pharmacist making theriac under physician supervision (woodcut, Hieronymus Brunschwig,
approximately 1512. Wellcome Library)
Modern study of old recipes shows variation in ingredients, some of whose names are no longer decipherable. The medicine developed a reputation as a cure or preventative for a variety of illnesses in addition to its actions on venoms and poisons. It was used extensively in plague epidemics both to prevent and to treat the pestilence and was considered effective for either. The ingredients, especially opium, could reduce diarrhea and cough and induce analgesia, sweating and sedation, adding patient satisfaction. Doctors gave it orally, usually in wine, or rectally, as a plaster, or by inhalation. 
Partial list of ingredients, 16th cent.
book (Wellcome Library)
During Renaissance times the Republic of Venice enjoyed a booming pharmacy business. The state’s extensive trading with the East supplied many of theriac’s ingredients. The first chair of materia medica was established in Padua in 1533 and a botanical garden followed soon after. By 1565 there were 71 pharmacies in the Republic, organized into a Collegio, whose pharmacists underwent years of training and an examination to obtain licensure. The Collegio fixed pharmacy prices so that a pharmacist’s success rested on the quality of his products (especially theriac) and his relationship with physicians. Physicians could not own pharmacies but worked closely with favored ones. The Campana d’Oro in Verona, the most famous pharmacy, also maintained a natural history museum that was a known tourist attraction. Another one, the Farmacia Dell’Orso, still operates in Venice.
Photo of model of 16th century Italian pharmacy (Wellcome Library)
Crowds gathered in the city every spring to witness the manufacture of theriac. Outside the licensed pharmacies benches supported numerous majolica jars containing herbs, spices, roots, gums, and other ingredients while larger jars on the top row held the snakes whose flesh was the vital component. Priors of the College of Medicine arrived to inspect the ingredients and spectators crowded in to witness the butchery of the vipers and watch the costumed workers grind and mix the herbs. Travelers sometimes came from afar to witness the spectacle. Up to 800 snakes (only females could be used) per month in some years disappeared into the concoction, eventually depleting the usual supply area near Padua.
Even at this time, arguments about the possible harms of “polypharmacy,” such as seen in theriac, appeared in print and they gained credence as botanical and pharmaceutic knowledge increased. A particular influence in the decline of theriac’s popularity in 
William Heberden (Wellcome Library)
England was a publication by William Heberden, Antitheriaka: An Essay on Mithridatium and Theriaca (1745). The essay details theriac’s poorly documented recipes and debunks the agent’s supposed curative properties. Regarding its opium content, Heberden urged that if the doctor needs opium, he should prescribe it separately. Heberden was generally skeptical of reliance on ancient authorities.
In Paris, residents last witnessed a Venice-like, public theriac manufacture in 1798 and the French Pharmacopeia listed theriac until 1884. Theriac is now a historical curiosity. Why did it have such a long life? The significant opium content certainly contributed to public and medical acceptance. And no doubt heavy promotion by purveyors, from doctors and elite pharmacies to itinerant peddlers, influenced an expectant public. Not unlike purveyors of vitamins and immunity boosters today.
A full index of past essays is available at: https://museumofmedicalhistory.org/j-gordon-frierson%2C-md
SOURCES:
Eamon, William, The Professor of Secrets: Mystery, Medicine, and Alchemy in Renaissance Italy. 2010; National Geographic.
Heberden, W, Antitheriaka. An essay on mithridatium and theriaca. 1745. Available at: https://wellcomecollection.org/works/ty3m7h5g
Berman, A, “The Persistence of Theriac in France.” 1970; Pharmacy in History 12(1): 5-12.
Fabbri, C N, “Treating Medieval Plague: The Wonderful Virtues of Theriac.” 2007; Early Science and Medicine 12: 247-83.
Rankin, A, “On Anecdote and Antidotes: Poison Trials in Sixteenth-Century Europe.” 2017; Bull Hist Med 91 (2): 274-302.
Palmer, R, “Pharmacy in the Republic of Venice in the Sixteenth Century.” Chapter in The Medical Renaissance of the Sixteenth Century, A. Wear, R K French, I M Lonie eds. 1985, Cambridge Univ Press.
