Theriac

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"Theriac is perhaps the most well-known medication in the history of pharmacy and it dominated the medical-pharmaceutical scene for more than a millennium; it was considered a panacea, an infallible remedy… the queen of antidotes" (Cappelletti p. 15). Its origin is legendary and is traced back to Crateuas, physician to Mithradates VI, King of Pontus (ca. 120-63 B.C.), who used to take poisons in doses sufficient to ensure immunity from possible assassination attempts. When his fortunes turned, his acquired immunity prevented him from committing suicide with poison after he had already given it to his daughters and he was forced to kill himself with a sword after witnessing their deaths. History contributed to the fame of mithridate, the name of the antidote, which took his name. It was modified by Andromachus, physician to Nero (54-68 AD), and called theriac, from the Greek thḗroin, or wild beast, as it was considered an antidote to poisonous bites. The key ingredient was the flesh of vipers, in the belief that the animal held the antidote as well as the poison. Theriac was included in all recipe books until the nineteenth century.

 

The Grabadin, an Arab recipe book of the twelfth century, citing Avicenna, described Theriaca Andromachi (also called Venice Treacle) as if it were a living being, with five ages, infancy, puberty, adolescence, "senectutem et decrepitam" (age and death) (c. 102r), related to the evolution of the effects with the passing of time after its preparation. Theriac can also be found in the Antidotary of Nicholas, the pharmacopoeia of the Salerno School, contemporaneous to the Grabadin. In addition to the antivenom properties, many others are mentioned, that it almost seems like a complete list of diseases: "contra gravissimas passiones totius humani corporis, epilepticis, catalepticis, apopleticis, cephalagicis, stomachicis, hemicranicis prodest; ad raucedinem vocis, et constrictionem pectoris optima est, arteriacis, asthmaticis, haemoproicis, icterics, hydropicis, peripneumonicis, iliosis, et vulnera in intestinis habentibus, nephriticis, calculosis, cholericis subvenit, menstrua educit, et foetum mortuum expellit, lepras, et variolas, et frigus periodicum" (c. 185v). The author recommended testing the medicine on a rooster, putting some of the poison on an incision made under the left wing close to the thigh and then applying some theriac: "si animal vixerit, erit theriaca bona et bonae aetatis; si moritur, sit prava" (c. 186v). For storage, lead containers were not advised "quia plumbum attrahit ad se venenositatem", nor those of iron, which could rust, but containers of gold or silver or glass were to be used. The maximum length of time in good storage conditions was 40 years, considering the changes in ages mentioned in the Grabadin. It was not to be administered before six months from the time of its preparation, which should take place in temperate seasons to facilitate the blending of honey used for mixing the other powdered ingredients and to keep it from freezing. Its preparation was complex. On the first day, some ingredients are crushed in mortars and they are combined with a little refined honey. They are set aside for three days. Other ingredients are pounded, sprinkled with wine, and combined with the preceding ingredients with honey, gum, turpentine (larch resin), balm and galbanum (resin of galbaniflua) well blended. It is sealed. The first month it is shaken vigorously twice a day for at least half an hour, the second month every four days, the third every seven, the fourth every ten, the fifth every fifteen and once in the sixth month. The theriac is then ready, making sure to keep it sealed and mixed when appropriate.

There are variants in the theriac recipe, with a prevalence of non-native plants to Italy. "Per l'approvigionamento dei vegetali esotici, Venezia si trovava in posizione privilegiata" (For the procurement of exotic plants, Venice is in a prime location) (Cappelletti p. 21). Hence the fame of Venetian theriac. Not only that: "it is the universal opinion of knowledgeable and expert Men, that there is nothing better than what is made in Venice, because here, more than any other place in the World, Vipers can be collected in good time, in the Euganean Mountains, the troches of which are one of the key Ingredients of the Same" (p. 432). The writer is a proud witness of the fame of Venetian theriac: Antonio De Sgobbis. In his Vniuersale theatro farmaceutico, the "Speziale allo Struzzo" exhibits the recognition for the preparation of theriac given to his pharmacy from the Venetian Senate, with the laudatory plaque with the lion of St. Mark placed "nel mezo del Ponte verso l'Officina" (on the Bridge midway to the Laboratory) (c. 432). Maybe a not-so-hidden desire of self-promotion to get to almost two pages the already long list of theriac’s benefits. Compared to the Antidotary of Nicholas version, the preparation is complicated: it increased the number of ingredients and the phases in which they are mixed in compound. De Sgobbis recommended to always check with a sieve or sifter "cribbio" or "tamiso", so that the powder of the mortar-pounded ingredients be fine and homogeneous and that the honey, wine, balms or juices used to bind result in an Electuary "perfectly mixed, exquisitely uniform, without the least appearance of any clumps, and most optimally incorporated, in a totally excellent Appearance; the Antidote thus produced as an esteemed Treasure..." (p. 428). Given the fame of the Venetian theriac, "THE MOST AUGUST VENETIAN DOMAIN, always had an inimitable vigilance, in order that in no way may any fraud or omissions be committed… THE MOST HIGH COUNCIL has provided oversight [by the "Medical Laboratories"] to the MOST ILLUSTRIOUS MAGISTRATE OF ANCIENT JUSTICE" (p. 431). The production of theriac was granted by licence to authorised pharmacies, around forty of them in Venice (Cappelletti p. 31), which required them to file their recipes and prepare it publicly. In the 1751 Antidotary of Bologna, theriac was the first Galenic medicine described, with the prohibition of producing it in private and the obligation of preparing it publicly under the supervision of the College of Pharmacists, "Conficiatur solemni ritu in Archigymnasio a Societate Pharmacopoeorum, coram universo nostro Collegio legitime convocato: privatim Theriacam componere nemini jus esto" (p. 3). With the preparation considered a "solemni ritu" (solemn ritual), because of the public aspect, together with the complexity of the recipe, transformed the event into a kind of show. De Sgobbis wrote about the public preparation of theriac in the year 1662 (pp. 431-432). Displayed for three days "su'l Ponte di Barettari avanti la Nostra Officina intieramente adornato con pompe convenienti" the "Materie Medicinali", selected with the diligence and decorum "dell'Arte Farmaceutica", "raccolte, ragunate, scelte, squisitamente disposte, & apparecchiate... sopra gran Bacili d'argento" (on the Ponte dei Barettari [milliners] in front of our workshop, completely decorated with due pomp the “Medical Sustancies”, selected with the diligence and decorum of the “Pharmaceutical Arts”, “collected, chosen and exquisitely displayed on Silver Trays). In this way, the ingredients were displayed for the assessment "not only of the Experts, the complaints of which they freely made, but also of All the other Foreigners, and Nationals, who passed along the Marceria, the busiest street of all" (still today). In the absence of comments, there was then the examination by a commission made up of the Superintendents of the Magistrate of Ancient Justice, the Court Prior, three Councillors of the College of Physicians (the trade association), and three members of the College of Pharmacists. In particular, they checked the seals of the containers of viper troches, which had to have "a certificate of authenticity ("fedi") issued by the Paduan physicians who were authorised to do so" (Cappelletti p. 21). The ingredients were weighed and placed in separate boxes, ratified with the seal of the Magistrate and the College. Next was the preparation, which lasted several days and was always monitored by public authorities, and this included the Trituration "by twenty-four Men, well vigorous, with as many great Bronze Mortars" and the "perfect Dissolution [of] the condensed Materials". Each day, at lunch hour or in the evening, the containers were sealed. The final phase was the "Incorporation of the Spices, and Powders, and the Dissolutions with Honey, and the perfect Mixture of the Antidotes and its reposition", and finally with the application of seals to the jars to store the theriac until its maturation and its release for sale. The Magistrate would take a sample to be stored in the institution’s "Armoir".