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Theriacs and Snake Bites

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Vipera aspis in France – By Orchi – Self-photographed, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=11182655

Theriacs were medicinal concoctions developed by the ancient Greeks (or even earlier) and used to treat toxic snake bites, scorpion stings and other poisonous contacts with animals.

Theriacs (from the Greek thēriakē, “pertaining to animals”) often consisted of dozens of herbal ingredients and other substances mixed together and fermented over months. They were applied to wounds as a salve or paste or consumed internally in chunks. Theriacs often featured many of the well-known natural remedies of Arabia, including honey, castor oil, ginger, cinnamon, anise, cardamom, pomegranate, black seed, myrrh and many others.

Theriacs were adopted by Arabic-speaking physicians of the Middle Ages and were used in the Islamic world and in Europe up to the 19th century. Theriacs were used by such prominent Muslim physicians as Ali ibn al-Abbas al-Majusi (known as Haly Abbas in the West), Abu Bakr Muhammad Al-Razi (Rhazes) and Ibn SIna (Avicenna), as well as by the Arabic-speaking Jewish scholar-scientist Maimonides, court physician of Saladin.

A medical historian recently cited an example of how theriacs popularized in Arabic medicine survived as standard practice in Renaissance Europe. The example appeared in a recent academic paper by Kathleen Walker-Meikle, a Wellcome Trust fellow in Medical Humanities at the University of York.

The account was written in the 14th century by Gentile da Foligno, professor of medicine at the University of Perugia in Italy.

The case involved a young man who was bitten on the ankle by a poisonous asp viper while hiking in the mountains near Perugia. The victim tried self-treatment, binding his leg above the bite to stop the spread of the venom, but his effort was in vain. The snake was brought in, and Foligno identified it as a short deaf asp (now identified as an asp viper or vipera aspis, known to have a powerful venom):

Foligno immediately went to work. First the Great Theriac of Galen was applied externally over the heart; then a cupping-glass to the wound location, which was then scarified, and the patient was given draughts of stale butter. The usual treatment of sucking the wound (after application of olive or rose oil to the practitioner‘s mouth) was not done, as no one was found willing to suck the wound with his mouth, on seeing the patient‘s symptoms. Foligno had made a theriac of ground-up gentian, balsam seed, rue, and anise, which was to be drunk with strong wine. On the second day, the patient was examined in the morning. The young man still had closed eyes, a heightened pulse and labored breathing, with a ‘foul’ face. Although the patient had difficulty in swallowing, he was given emerald powder was given along with citrus seeds infused in wine. Maimonides cited the beneficiary power of emerald powder and citrus seeds, and Foligno would use these two ingredients throughout the treatment.

The snake-bite victim had great difficulty swallowing medicine. Later the same day, the patient had not improved and his urine was described as “livid”:

Foligno sent him to his associates for a second opinion and when he returned gave him the theriac of Haly Abbas made of castor oil, cassia wood, round aristolochia, anise seed and pepper, and given with wine. It caused the patient to speak for the first time, and by that evening the patient was conscious and had recognized the doctors. Foligno prescribed emerald powder, citrus seeds and two doses of the Haly Abbas theriac for the night, along with massage and for the patient to be kept awake.

On the third day, his condition had stabilized but not improved, so he was given chicken soup with emerald powder and citrus seeds sprinkled on top, as well as more theriac and some cupping of the wound.

By the fourth day, Foligno found the patient with an improved urine despite a complaint of stomach and kidney pains. Foligno prescribed a clyster of milk and decoction of mallow. The patient was then to be washed with a decoction of aristolochia rotunda and Haly Abbas theriac was administered again. By the fifth day, the patient had much improved and the prescription of Haly Abbas theriac was stopped and a diet of good food and wine was prescribed, with a suggestion to eat something sour in two days time due to the hot poison causing ‘derangement,’ as that species of snake‘s venom affected the brain and nerves. Foligno finished his account by noting that most people bitten by the deaf asp do not open their eyelids for months, citing Avicenna.

In short, the patient recovered.

 

 

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