One hundred years preceding the Common Era and well before the advent of informed consent in human clinical trials, King Mithridates VI of Pontus (the area of the southern Black Sea coast in present-day Turkey) assumed the mantle of clinical trial researcher, his objective to test poisons and antidotes on people.¹ He did so, unreservedly, on both himself and prisoners, and the fruit of his study, “Mithridatum,” is by some dubious accounts the progenitor to what may be the most famous concoction in the history of traditional medicine: theriac (in Arabic, diryâq).¹

Theriac—rooted in the Greek word thèrion, “a fierce and venomous beast”—was primarily a treatment for poisons and venoms; its history of use stretches back more than 2,000 years.^3,4 So pervasive was the formulation that 2^nd century Greek poet and physician Nicander described theriac as a kind of universal elixir—“a remedy against all scourges.”³ Myriad recipes composed of 5 to several dozen ingredients exist for the plant-based remedy.³ In the 1^st century CE, Roman naturalist Pliny the Elder put down what is believed to be one of the oldest formulations—the “Theriac of Antioch”—in his Natural History; 2^nd century CE physician Galen of Pergamum name-checked the very same preparation in De antidotis.³ (Depending on the source, this particular recipe dates as far as a century in advance of Mithridates’ reign). However, it is Roman emperor Nero’s physician, Andromachus (1^st century CE), who is credited with devising the most noted theriac, adapted from the Mithridatum.³ His remedy, transcribed in the form of a poem in Galen’s De antidotis (as well as in his De theriaca ad Pisonem), comprised more than 70 ingredients, and was the first to include viper’s flesh in addition to herbs such as wild rue (Peganum harmala, Nitrariaceae), sweet flag (Acorus calamus, Acoraceae), opium (Papaver somniferum, Papaveraceae), rose (Rosa spp., Rosaceae), and cinnamon (Cinnamomum zeylanicum, Lauraceae).³

Traditional Arabic medicine of the first and second millennia CE was rooted profoundly in Greco-Roman medicine, with Greco-Roman classic medicinal theory, practice, and texts being incorporated and improved by leading Persian and Arabic physicians. In the 9^th century, Ḥunayn ibn Isḥāq of Baghdad generated a summary of Galen’s treatises.³ Also in the 9th century, Ayyūb al-Ruhāwī translated De theriaca ad Pisonem into the Syriac language; Yahyā ibn al-Bitrūq followed suit and translated it into Arabic.³ From these renditions sprung the comprehensive and beautiful Book of Theriac (Kitâb al-Diryâq in Arabic).

The Paris Kitâb al-Diryâq manuscript was acquired by the National Library of France in May of 1879 for the scant sum of 1,000 francs (about 200 USD).² The previous owners of the precious 12^th century illustrated medical text included a Parisian physician, and, before him, a pharmacist.² A precise compendium of theriac preparations and indications from 9 Greek physicians of Classical Antiquity, the Paris Kitâb al-Diryâq is one of 5 known copies of the Arabic Book of Theriac. Exactly where the tome originated and how it wound up in France is yet an enigma.^2,3

In Valentino Mercati’s Foreword to Aboca Museum’s edition of the Kitâb al-Diryâq, (Theriaque de Paris), he characterizes the manuscript as an example of early medieval globalization.⁴ Indeed, it represents the “transmission of Greek and Hellenistic medical knowledge to the Arab world,” as Françoise Micheau states in her essay “The medical value of Theriac.”³ Included in the book are depictions of all 9 Greek physicians whose theriac formulas are included, and, on the Paris manuscript’s page 33, the Kitâb al-Diryâq’s calligraphic scribe goes so far as to misattribute authorship to Galen himself, from whose oeuvre much of the manuscript’s content is accurately derived.^3,5 Its organization is systematic and lucid, illuminated by Micheau as follows:

First [the Kitâb al-Diryâq] describes the various steps that characterize the growing number of drugs and of therapeutic uses: the theriac of Andromachus the Elder that contained 5 drugs and had 9 indications; that of Heraclides with 9 drugs and 13 therapeutic indications; that of Philagrius with 11 drugs and 17 indications; that of Proclus, which was the first to introduce scilla [squill, Scilla spp., Asparagaceae] tablets; that of Pythagorus (described in the pages missing from our manuscript); that of Marinus with 19 drugs—including scilla tablets—and 16 therapeutic indications; lastly, that of Magnus with 38 drugs, the scilla tablets and—another new element—the Hedychroum [a mixture of herbs intended to reduce the odious fragrance of other ingredients] tablets. It then presents in detail the theriac of Andromachus, the introduction of viper flesh, the substances that are included in its composition, and its 91 therapeutic indications.³

The exquisite geometric patterns of the manuscript, Micheau adds, also serve the functional purpose of enhancing the clarity of the Kitâb al-Diryâq, as they follow a traditional Arabic way of presenting medical information through forms and shapes (called shakl).³ However, Oleg Grabar, PhD—in his “The Paris Kitâb al-Diryâq, an Essay in Interpretation”—asserted that the presentation does not necessarily indicate that the book was used in practical medicine, and that the designs complicate ease of reading.⁶ “The whole manuscript is and was meant to be a work of art rather than a work of science or learning.”⁶ According to Dr. Grabar, because of the limited known copies of the manuscript, it is also unlikely that the book was a popular text, but was created rather for the personal use of “a learned religious and social leader… who felt that a fancy pharmaceutical book is [sic] appropriate for his collection.”⁶

As it exists today, the Paris Kitâb al-Diryâq consists of 37 2-sided folios (74 pages), each measuring 37 x 29 cm.² Some leaves are incorrectly numbered in red ink—probably the work of a former owner or researcher—and entire tracts did not stand the test of time and travel.⁶ Two other copies of the Kitâb al-Diryâq, the “Vienna” manuscript and an un-illustrated copy sold at Sotheby’s, were used to repaginate credibly the incomplete Paris manuscript.

Once the “most famous preparation in the Western pharmacopoeia”—iterations of which were used in the 1400s to attempt to treat the Black Death and are documented to have been employed for other ailments into the late 1600s—theriac has faded from ubiquity, disappearing altogether from contemporary conventional pharmacy.² The 1908 Faculté de mediciné Codex elegantly painted the wane of theriac as such: “Having held such a great and long-lasting place in pharmacy and therapeutics, it has left the domain of history to be relegated to that of legend.”²

Nevertheless, despite its being abandoned in modern medicine and pharmacy, theriac, as it is portrayed in the beautifully illustrated Paris Kitâb al-Diryâq manuscript, hearkens to a time when flora and fauna played a more critical role in the lives of people seeking various ways to enhance their health and wellness.

—Ashley Lindstrom

* Cutlines adapted from Kitâb al-Diryâq, Aboca Museum Edition (2009).

References

1. Bender G. Great Moments in Pharmacy. Detroit, Michigan: Northwood Institute Press; 1966.
2. Guesdon M. History of the manuscript and codicological presentation. In: Kitâb al-Diryâq, Theriaque de Paris. Aboca Museum Edition. Sansepolcro, Italy: Aboca Museum. 2009;13-19.
3. Micheau F. The medical value of the Book of Theriac. In: Kitâb al-Diryâq, Theriaque de Paris. Aboca Museum Edition. Sansepolcro, Italy: Aboca Museum.2009;49-75.
4. Mercati V. Foreword. In: Kitâb al-Diryâq, Theriaque de Paris. Aboca Museum Edition. Sansepolcro, Italy: Aboca Museum. 2009;7-11.
5. Kerner J. A descriptive reconstruction and catalogue of the Paris Kitâb al-Diryâq. In: Kitâb al-Diryâq, Theriaque de Paris. Aboca Museum Edition. Sansepolcro, Italy: Aboca Museum. 2009;77-223.
6. Grabar O. The Paris Kitâb al-Diryâq, an Essay in Interpretation. In: Kitâb al-Diryâq, Theriaque de Paris. Aboca Museum Edition. Sansepolcro, Italy: Aboca Museum.2009;21-34.

Page 57: Paris Manuscript’s p.57

This is the only herbal page in the Paris Kitâb al-Diryâq animated by figural illustration. In the central compartment of the upper register, a male figure sits before a balsam tree (Colophospermum mopane, Fabaceae) extracting its oil with a thin, tube-like device. The other ingredients depictured include on that is not a plant, vitriol, along with gentian (Gentiana lutea, Gentianaceae), valerian (Valeriana officinalis, Valerianaceae), malabathrum (Cinnamomum tamala, Lauraceae) or Indian sesame (Sesamum indicum, Pedaliaceae), and black pepper (Piper nigrum, Piperaceae).

Page 58: Paris Manuscript’s p.36

Page 59: Paris Manuscript’s p.37

Together, these two folios form the manuscript’s double frontispiece. The folios are virtually mirror images of each other, each one framed by a delicate band of gold with red lozenges and groupings of four blue dots. Depicted on each folio is a central crowned and seated figure holding a crescent and flanked by two smaller figures differentiated in appearance primarily by the colors and patterns of their garments. A pair of entwined dragon-headed serpents, knotted at the cardinal points, encircles each group of 3 figures. Four winged figures inhabit the corners of each picture plants.

As a whole, the composition is unparalleled in Islamic manuscript painting. Its individual motifs, however, emanate from the wider visual vocabulary of the period in which the manuscript was copied, especially the region to which the book is usually attributed (the Jazira). All of the figures are female; the central figures even wear earrings and nailpolish, now tarnished and blackened, likely the result of oxidized silver paint. An all-female “cast” is unusual in frontispiece imagery of the medieval Islamic period, but not completely unknown. The seated figures supporting crescents are the usual anthropomorphic symbols for the moon. As an iconographic type, this figure dates back to the ancient Mesopotamian cult of the stars; in ancient legend, the figure stood for the moon-god, the father of the sun god and the planet Venus. In Islamic art, however, the moon-figure is often portrayed as female in gender. Similar figures appear on the figural coinage of late 12^th century northern Iraq and in Iranian and Jaziran metalwork of the 12^th and 13^th centuries. Related figural themes were also employed in architectural decoration, especially above archways of city gates, such as the now-destroyed Sinjar Gate of Mosul, and in the portable arts.

Entwined serpentine dragons were also recurring themes in various media from the 12^th century on, including coinage, architecture (again servicing as talismans in the context of gateways), and metalwork. The paired attendants and the 8 winged figures flanking the central lunar figures are elements typically associated with royal imagery, especially enthronement scenes.

Bishr Fares, the “discoverer” of the manuscript, interpreted the double frontispiece as a talismanic image offering protection against snakebite (and evil more generally) to the book’s owner. The folios’ inscription bands, which are to be read across both pages, would appear to support such a hypothesis. They conclude a repetition of the invocation used in the book’s opening, in which the scribe, Muhammad, asks for God’s blessing.

This invocation, in combination with the imagery, suggests comparison with metalwork decoration of the period, in which inscriptions wishing power, health, fortune, or other blessings were often combined with figural decoration of a symbolic nature. The symbolic elements were usually zodiacal constellations or other propitious heavenly bodies—amalgams of Greek, ancient Mesopotamian, and Indian ideas—intended to protect the object’s owner or maker. Such text-image combinations served a clearly apotropaic function, and while the meaning of the Paris Kitâb al-Diryâq’s frontispiece remains somewhat enigmatic, it seems likely that its iconography and inscriptions served a similar talismanic function. Two tapering teardrop-shaped motifs, bordered by a series of individual units similar to the figures’ “flaming” haloes, adorn each margin, and flank a central arabesque filigree in gold with colors similar to those of the border.

Page 61: Paris Manuscript’s p.34

 The upper and lower registers of page 10 contain the Basmala and a repeated phrase from the work’s title:

“In the name of God, the merciful, the compassionate. Fundaments of the first discourse of the book…”

The three physicians depicted on page 10 are, from right to left, Marinus, Andromachus the Elder (distinguishable only by his white beard, not by name), and Andromachus the Younger. Each physician’s name is inscribed above his image.

Page 63: Paris Manuscript’s p.17

The text of this page opens with the etymology of the term “theriac” from the Greek. The first line, in red angular script, states that “the first to call the theriac [by the name] ‘theriac’ was Andromachus [the Elder]” and that he called the theriac by this name for two reasons. The first is that it is useful for the sting of predatory vermin, called by the Greeks “tirya.” Secondly, it is useful for poisonous drugs that are drunk, and their name in Greek is “qa.” He joined the 2 names, calling it “tiryaq” (because it was useful for both purposes. The following lines conclude the account of Andromachus the Elder, and open that of the second physician, Abraqlidis (Heraclide).

The folio’s lower half is illustrated with a scene of Abraqlidis’ preparation of the theriac. Such compositions, which depict the preparation of a medicine by a physician, usually in the company of an assistant, are often referred to as “explanatory drawing.” The term is somewhat misleading, however, as most explanatory drawings are fully developed paintings. Superficially, such drawings served as practical aids to understanding a test (often, Arabic versions of the herbal of Dioscorides). Over time, however, stock formulae were developed, and the miniatures became increasingly self-contained and independent of their text. The Paris Kitâb al-Diryâq contains 2 illustration of this type, both of which are highly unusual, in that the images far surpass the requirements of the text.

Here, Abraqlidis is seated on a cushion and rug, against a tall chair, at left. He holds a book with his left hand, and extends his right hand in a gesture of speech, as if directing his assistant; the latter crouches nearby, measuring ingredients with a scale. Four young attendants also populate the scene; one carries a vessel and another object, which may be interpreted as a bag containing theriac ingredients. At the far right, another youth, drawn in profile and holding a staff, sits (or sleeps) on the ground. The architectural setting, in which hangs a “curtain,” is quite similar to those of 2 of the physician’s portraits. Just above the illustration is a wide inscription in black angular scrip that reads, “Then Abraqlidis emerged [from his studies] when he reached…” The phrase is completed by the line below the illustration: “twenty-five years of age.”

Page 62: Paris Manuscript’s p.54

The inclusion of 12 pages with depictions of plants and other substances used in the preparation of the theriac is a unique feature of the Paris Kitâb al-Diryâq. On each page, 6 or 7 plants are represented beneath a band of calligraphy identifying each subject. The plants names, like the headings of the rest of the manuscript, are written in an antiquated angular script against a vine scroll background, in alternating black and red ink.

This folio’s plants include cardamom (Elettaria cardamomum var. cardamomum, Zingiberaceae), galbanum (Ferula gummosa, Apiaceae; a resinous plant), cinnamon (Cinnamomum verum, Lauraceae), valerian, and licorice root (Glycyrrhiza glabra, Fabaceae).

Page 65: Paris Manuscript’s p.53

A diagram of the 96 “simple” ingredients in Andromachus the Younger’s theriac fills the page. It includes the component ingredients of the three “cakes” as well as the 70 additional simple drugs. The folio’s rectangular border contains an unusual inscription. Following the identification of the diagram as a summary of the 96 ingredients is the phrase:

“And this theriac is named after the hakim (physician philosopher), amir (leader/prince) of humanity, Andromacus, who God, praise be upon him, protected with his grace.”

This statement is extraordinary in its bestowal of the protection of the God on the pre-Islamic physician. The passage’s apparent intention (like the images of the physicians dressed in medieval garb illustration the manuscript) was to “Islamacize” the ancient physician. No such passage appears in the Vienna or Sotheby’s manuscripts. The Paris manuscript’s scribe clearly has extra space to fill in his border inscription, but the lines he wrote (or perhaps copied from an unknown prototype) defy convention.

Page 64: Paris Manuscript’s p.15

The text of this folio’s upper portion contains the recipe of Aflaguras. Because, as the uppermost inscription band tells us, Aflaguras lacked precise measurements, his ingredients are gauged in “parts.” For example, for the first group of ingredients, 2 parts were required; of the second group, 4 parts, and so on. An explanatory drawing depicting the preparation of Aflaguras’ theriac occupies the folio’s lower portion. This illustration is populated by a variety of spectators, assistants, and patients. The identity of the physician is somewhat ambiguous, in that he may be identified either as the seated figures stirring the mixture, or as the dark-bearded, standing figure. A shallow vessel resting on a stand above a fire dominates the center of the composition. A baldheaded, unbearded figure contorts himself to keep the first burning; bellows lie on the ground near his feet. The bearded figure stands behind the preparation area, carrying a round disk-like object (perhaps a bowl, drawn from a birdseye perspective). At left are 2 veiled female figures, one of whom carries a baby. Before the women crouches another bearded male, who may be interpreted as a patient waiting for the remedy. At right stands a hunchbacked figure with a staff. Completing the scene is a semi-clothed, emaciated man who sits in the foreground—likely another patient sorely in need of a dose of theirac. With his right hand, he gestures toward an open-mouthed, coiled serpentine dragon, which is drawn as if in front of the stepped seat. A polylobed arch, complete with a “curtain,” frames the picture plane. Such compositions, scenes of everyday life with a variety of characters, have often been described as genre scenes. This genre quality extends to most of the Paris Diryâq’s imagery, but is not unique to the manuscript. The resulting contemporization of the manuscript’s illustrations sets the activities of the ancient physicians within the medieval Islamic milieu. Just above the illustration is an inscription in blue angular script serving as another de facto “caption.” It reads:

Page 67: Paris Manuscript’s p.29

The 5 plants of the manuscript’s final herbal page yield bitter frankincense (Boswellia sacra, Burseraceae), opium (Papavaver somniferum, Papaveraceae; drawn as a poppy plant with red flowers), aristolochia/birthwort (Aristolochia longa, Aristolochiaceae), rose (Rosa spp., Rosaceae), and white pepper (Piper album, Piperaceae). In the left-hand compartment of the lower register, there is a depiction of what appears to be a quadruped, labeled. Its head has been partially erased. It is rodent-like in appearance, with a long tail and a flattened, splayed body, as if viewed from above.

Its head faces left, and has small rounded ears and a long snout. The second part of its name, may mean “female” in this context.

Page 66: Paris Manuscript’s p.52

The 6 plants depicted on this page include two varieties of valerian.