ANCIENT GREEK MEDICINE

Prof. Dr. Ayşegül Demirhan Erdemir

e-mail:aysegul.erdemir@yahoo.com
Ancient Greek medicine can be divided into two
periods:

1) Mythological Period: From the Trojan Wars

until the era of Hippocrates.

2) Scientific Period: It begins with Hippocrates.

 Mythological Pediod:
Chiron who was a mythological person, was
accepted as founder of medicine during the
mythological period. According to the belief of
that age, he was the son of a Fertility God. Saturn
and of a fairy, called Philliria.

In this age, we observe that Aesculapius

appeared as Health God in Polytheistic Greek
temples.
According to the belief of Teselia, Aesculapius
who gave expectancy and cure to humanity, was
the son of Sun God, Apollo and of a woman, called
 Aesculapius was also a king of Teselia who had
the force in the epics of Homer and then became
God. But, althouugh no Aesculapius' statues in
various museum resemble one another,
we can say that he might have been an imaginary
per­son. A stick, a snake, a cock or a bowl are
found near the statues if we examine the statues of
Aesculapius.
 
 The stick on which Aesculapius was supported is
the sign of a long life of 90 years and especially the
snake shows carefullness and intelligence. All of
these symbols mean that, in the advanced ages, a
physician must be a man who works and offers
cures.
As for Aesculapius temples. Aesculapions, these
temples that were founded for Aesculapius in
Greece, in those ages and even in Italy were more
than 200 some small and others big and the places
of many of them are not known, today.
 The first big one was founded in Titan, Italy in the
IV th century B.C and then, the temples in Rhodes,
Istankoy, followed this .

Following two centuries, some aesculapions were

founded in Epidauros, Athens, Alexandria.
Moreover, Aesculapion in Pergamum was one of the
famous aesculapions and it was established in the IV
the century A.D. In addition to this, the aesculapion
in Tiber was the important one of the third century.
These foundations resemble our sanatoriums or
hospitals of today.
 Small aesculapions that were in the form of
sanctuaries, resemble welfare centers of to­day.
Just as big aesculapions were foundations of
treatment and also they were establishment of
education.

Because, the basis of cult of Aesculapius

depended on cleanliness, the therapies of water
and sun were applied here and besides, the
methods of physical therapy, hygienic rules and
the treatment of diet were also carried out.
Moreover, psychotherapy was also ap­plied in this
civilization.
 Besides, well-known treatments of drug and
small surgery took place. According to the cult of
Aesculapion, birth and death were forbidden in
these temples. Therefore, patients who applied for
the temple, every morning were examined by
priest- physicians, called Aesculapion and
severely ill patients and pregnant women weren't
accepted in the temple.
For this reason, the morale of every patient
who entered the temples, was strengthened at the
gate of this foundation and everybody who
entered the temple, understood that his disease
 This was a kind of therapy of suggestion
(psychotherapy). The patients washed themselves in
the bath in the middle of the court.
 Thus, today, it is known that these baths in
Pergamum have strong radioactivity. After these
works, the patients went to big dormitories in the
temple. The priests gave suggestions and advice to
patients who came here and they said that they
mustn't forget their dreams, Aesculapius cured their
diseases.
In these temples, the patient was treated by
incubation; he slept a night in the temple of the God
and during his sleep, the God would appear to him
and prescribe for him. The next morning, the priest-
physician who explained dreams, diagnosed every
disease.
 When Christianity became strong in Rome in the
second century A.D, it was the official relig­ion of
state. Aesculapions were destroyed because of the
effect of this religion. It is a lucky co-­incidence
Aesculapion of Pergamum was rescued from this
destruction, because it remained under the soil in the
an earthquake and it was again restored in the XX th
century at the end of the works of archaeologists like
Prof. Schazmann, Prof. Aziz Onan and Prof.von
Theodore Wiegard.
So, Aesculapion of Pergamum is the only sample
that can give an idea about aesculapions and it is still
standing.
Philosophic Period:

Some philosophers also explained some thoughts

in the field of medi­cine in this period. These kinds of
scholars observed the events in nature and they
reached for some findings. That is, they evaluated
only the experiments and events. The power of
imagina­tion, thought and logic were their basic
subjects. They also emphasized transmutation and
evo­lution.
Thus, Thales of Miletus (624-585 B.C), regarded
moisture as a fundamental element; Anaximenes of
Miletus (556-460 B.C) chose air.
 Pythagoras of Samos (580-489 B.C) accepted the
theory of four principles. These were fire, air, earth
and water and everything resulted from these
elements.

Empedocles of Agrigentum (504-433 B.C) also

worked in Sicily. He was prob­ably the originator of
the theory that replaced the one fundamental
element of the former phi­losophers with four; air,
fire, water and earth.
Empedocles wrote the characteristics of the four
elements: hot, dry, wet and cold. A fur­ther step was
to identify the four basic elements with the four
constituent humors of the body: blood, phlegm,
yellow bile and black bile. These four humors
orginated in the heart, brain, liv­er and spleen
respectively.

The popularity of this theory can probably be

attributed to its sim­plicity. A disease of the black
bile, for instance, which was dry and cold, would
logically be treated by hot and wet remedies.
 During the fifth century, the interest of the Greek
philosophers shifted from natural toward moral
philosophy. One of the last natural philosophers,
Alcmaeon of Crotona (about 500 B.C) is one of the
first Greeks known to have written about medicine.

Alcmaeon advanced the theory that disease is a

state of disequilibrium among the qualities of the
body components. At the same time, Alcmaeon was
greatly interested in anatomy and embryology. He
described the op­tical nerve, two kinds of blood
vessels and trachea.
 He designated the brain as the central organ of
the higher activities of man. Many ancient and later
writers regarded it only as a gland se­creting phlegm.

Another fifth-century philosopher. Democritus of

Abdera (about 460 B.C), de­serves mention for his
theory of the atoms as minute bodies representing
the ultimate unit in the physical world. Not only has
this theory been incorporated into modern science,
but it also exerted great influence on many ancient
medical writers.
Scientific Period:
The scientific era began with Hippocrates (460-
377 B.C) in ancient Greece. The name of
Hippocrates-the father of medicine- is a symbol of
the first creative peri­od of Greek medicine.
Hippocrates was born in Cos on the island of
Istankoy.
He learned med­icine in an Aesculapion where he
was born and he became priest-physician there in
time, Hippocrates founded an open air school when
he became a famous person in medicine. So, and old
plane tree under which he gave lessons, is still
standing in Istankoy, today. He died in Larisa, called
 But, his grave was lost. 12 books that belonged
to Hippocrates, were translated into French by E.
Littree (1801- 1881), French physician, master of
language and medical history. This translation was
made in 1839-1861 years and it was published
with the name of Corpus Hipocraticum and then
was translated into many languages.
 Thus, the works of Hippocrates were collected in
the library of Alexandria and they were translated
into Arabic and Syriac language. On Ancient
Medicine is a typical of Hippocrates writings in
deriving the whole art of medicine from dietetic
observa­tions and practices. Moreover, the famous
Epidemic Diseases was concerned mainly with the
diseases of the Island of Thasos.
The admirable On Prognosis reveals the intimate
knowledge of symptoms possessed by the
Hippocratic physician and gives highly
sophisticated descriptive details.
 
 On Airs, Water and Places advised the physician
of the diseases he will have to cope with on
entering a city with given climatic conditions. In a
second part of the work, various countries of Europe
and Asia and their institutions are interpreted in
terms of climate.
The sur­gical books, dealing with fractures,
dislocations, wounds of the head, ulcers, fistulas and
hem­orrhoids, are still regarded as explanation their
descriptions, though they emphasize the conser­
vative more than the operative ascepts of surgery.
 On the Sacred Disease makes a strong plea for the
natural explanation of disease as opposed to the
supernatural. The book also stressses the importance
of the brain.

On the Nature of Man an anatomical and

physiological treatise, goes the furthest among the
Hippocratic writings in the acceptance of the theory
of the four humors.
The famous Oath. The Law and the Physician
deals entirely with the professional atti­tude and the
ethical obligations of the physician.
 
 The Aphorisms discusses all aspects of medi­cal
practice and is particularly detailed on the subject of
the critical days in the development of a disease.
Finally, here are some examples from Aphorisms:
"Fat persons are more exposed to sudden death than
slender ones". Those who faint frequently, and
without apparent cause, are liable to die suddenly." .
 A few idioms of Hippocrates that were in the form
of proverbs, are as follows from the point of
medicine:
 
" Don't cause harm to the patients,first of all."
"Stop pains."
"Wherever you see an abscess, clean and evacuate
it".
"Don’t apply abortion".
"The duty of a physician is not only scarcely to cure
a patient, often to stop his pain but al­ways to
consule".
The discoveries of Hippocrates about medicine are
as follows:
 
1.Hippocrates believed the theory of Humoral
Pathology. The health and the disease are related to
balance and disequilibrium of these humors in the
body and the organism al­ways works to maintain
this balance.
 For Hippocrates, disease was not a localized
phenomenon, but a disturbance affecting the whole
person through some imbalance in the four humors-
blood, phlegm, black bile, and yellow bile.

The four humors and the four associated qualities-

hot, cold, moist, and dry-in the microcosm or small
world of the human body corresponded to the four
elements-earth, air, fire, and water-that make up the
macrocosm or universe.
 Various texts in the Hippocratic collection offer
observations and theoretical rationalizations
concerning the relation ship between health and
disease and the humors, qualities, and elements, but
these explanations are sometimes obscure and
inconsistent.
 2.Especially , Hippocrates followed the evacuant
method in therapy, because, he empha­sized the
humoral pathology in etiology of disease and for this
purpose, he made use of blood letting, lavement,
purgatives, emetics and diuretics.
 
3.To Hippocrates, although, there was a reason for
every disease, it wasn’t easy to know it. So, the
diagnosis of diseases can be made with their
symptoms.
Thus, the observation and the experiment that were
the basis of positive science of today, first took place
in the school of Hippocrates. Observation in the
Hippocratic period was primarily based on in­
spection and palpation. The sense of smell was also
used and a crude kind of ausculta­tion was practiced,
as for instance in the so-called succession, which
consisted of shak­ing a patient and listening for fluid.
 The Hippocratic writings deal mainly with acute
easily identifiable diseases, such as the present-day
disease entities of pneumonia, phtisis, puerperal
fever, anthrax, mumps and particularly malaria.
Diseases were classified only into the acute and the
chronic, the epidemic and the endemic.
The Hippocratic phy­sician was primarily
interested, not in diagnosis, but in prognosis and
treatment. His first interest was not in a disease
manifested in the patient, but in the patient himself.
He was concerned with the body as a whole rather
than with the lesion of parts . 
 Alexandrian Period
In the third century B.C, the center of Greek
civilization and medicine shifted from the old
Greek settlements, towards the new Egyptian city
of Alexandria. This city was named after the
Macedonian King, Alexander the Great who carried
Greek civilization to the limits of the then known
world.
In the strange cultural melting pot of Alexandria,
Greek science produced some of its greatest
achievements and, conversely, oriental mysticism
gained greater influence on Greek thinking.
 On the other hand a utilitarian attitude brought
about great progress in the sciences-astronomy ,
geography and the mathematics of Euclid and
Archimedes and particularly in the field of
technology, as illustrated by mechanics of Hero and
Archimedes.

The wonder­ful libraries of Alexandria and its

museum , a combination of boarding house for
scholars and a university, offered unique
possibilities for a luxuriant growth of scholar ship.
 The early Alexandrian period is the only period in
the history of Greek medicine where dissection was
le­galized. This produced the most gratifying results
for anatomical and surgical knowledge.

But, original work finished quickly, because,

medical thoughts became fanatic in the course of
time after a short time. Priest-Instructors of the
school of Alexandria that envied advanced ideas of
Aristotle and his school played a great role in this
retardation.
 So, the Alexandrian School lost its fame in a
short time and especially following the invasion of
Rome in the first century. B.C. Moreover, the
greatest characteristic of the Alexandrian school was
polypharmacy in the area of treatment and
pharmacology.
Instead of an effective drug for a disease, a
different drug was used for every symptom of the
same disease.
 
 Other emphasis of Alexandrian school in the field
of medicine was appearance of rootsellers.
Proxagoras, Heraphilus, Erasistratus and
Theophrastus were among the scholars of
Alexandrian school.

Proxagoras lived about 340

A.C and seems to have been the
first Greek physician to make a closer study of the
changes of the pulse in disease. Heraphilus of
Chalcedon ((about 300 B.C) made important
contributions to all fields of anatomy.
 He gave good descriptions of the eye, the brain,
the vessels of the body, the duodenum (named by
him), and the male and female genital organs. He
tried to make pulse observations more objective
counted the pulse with a water clock.

In the clinic, Herophilus put far more reliance on

polypharmacy and bloodletting that the
Hippocratics had done .
 None of the sixty-two books of Erasislratus of
Ceos (330-250 B.C) has survived . Erasistratus, too,
was a great anatomist.

He noted the existence of separate sensory and

motor nerves and gave many details about the
anatomy of the brain and cerebellum, the heart and
the veins and arteries.

He tried to approach the riddle of metabolism by

weighing the intake and excrement of bowels.
Erasistratus made the first observations in
 He not­ed the hardening of the liver in ascites and
regarded the former as a cause of the latter. He ac­
cepted the consequences of his anatomical research,
he gave up Hippocratic humoral pathology in favor
of a pathology of solids.
He regarded atoms as the essential body elements.
These at­oms, he reasoned were vitalized by external
air (pneuma) circulating through the arteries. He had
a purely mechanistic concept of digestion and
regarded disease as primarily caused by a lo­cal
plethora interfering with the circulation of the
pneuma.
 Both Herophilus and Erasistratus were the
founders of schools which lasted until the second
century A.D

Theophrastus (370-288 B.C) who was the father

of botany, historian of nature and a great Greek
philosopher, was under the effect of Hippocrates.
He wrote some books about plants
Empricism Period
Toward the end of the third century B.C, a medical
group developed in Alexandria. They called
themselves Emprics. Philinos of Cos (about 250
B.C), Serapion of Alexandria (about 220 B.C) and
Glaucias of Tarus (about 170 B.C) were the
pioneers in this movement. Heraclides of Tarus,
who lived at the beginning of the first century. B.C,
was perhaps the fore­most of the empiricists. His
experiments with drugs made valuable
contributions to the field of medicine.
 These physicians used some drugs according to
some symptoms of the diseases. Empiricism
continued in the area of treatment for many
centuries because, it depended on a method of
simple treatment.
Empiricism, while not a dynamic factor in the
future devel­opment of medicine, enriched spesific
fields, particularly symptomatology, pharmacology
and surgery.
ROMAN MEDICINE
Physicians of Rome were divided into four
categories in those ages:

1.Physicians of the palace.

2.Physicians of the Municipality.
3.Physicians who worked in Gymnasiums or in
temples of Vesta.
4.Physicians of the people: These worked
independently.
 At the beginning, Etrusks that we think to be an
Asian tribe, affected the medicine of Rome. But,
Etrusks were under the effect of Mesopotamia.
Medical practice couldn't be devel­oped very much
in Rome because Rome emphasized very much the
management of state, that is, law and military
service.
For this reason, we see that medicine of ancient
Greece and espe­cially the school of Alexandria
dominated Rome in this field.
 At this time, medicine of Etrusk slowly lost its
fame in the third century. Although, there were
traditions of society, the right of citizen-ship was
given to them, in order to attract physicians of
Greece in the period of Caesar.
Today, there are a number of sources belonging
to ancient Rome. According to these sources, there
were free physicians who worked independently in
offices that they opened, as well as ci­vilian and
military physicians in Rome of those ages and some
of them prepared only drugs and didn't examine
patients.
 The Romans, with their essentially utilitarian
approach, did great things in the fields of law,
government, warfare and architecture, but they
never developed any original talent in philoso­phy,
art or science. Latin medical works were essentially
compilations.
 Some famous physicians developed the medicine
of Rome. Pedanius Dioscorides (First century A.D)
was a Greek physician of Anatolia. He went to
Rome after he had learned medi­cal practice in
Alexandria and Athens and he worked in the armies

of Emperor Nero (54-68

A.D) as soldier-physician.
 Dioscorides was who described about six hundred
medical plants, is the father of Materia Medica. The
origin of this work that preserved its importance till
XVI th century, was in Greek and especially it was
later translated into Arabic and Latin languages.

Its Arabic translations are called Kitab-ül

Haşayiş. Mineral, vegetal and animal drugs are re­
corded in this manuscript. Although, Dioscorides
used Mandrogora in operative interventions, he also
knew opium.
 In fact , Dioscorides was the first physician who
prepared opium as a drug, in the sense of today. At
first, opium was prepared by the mixing of honey
and popy boiled in wa­ter.

But, later, Dioscorides began to use the extract of

opium because it was understood that this
composition was dangerous. The pointing out of the
different effects of various pharma­ceutical matters
was a great discovery of Dioscorides .
 Aulus Cornelius Celcus (3-64 A.D) was from
Latin race and belonged to the noble Cornelium
family. Celcus was a barber-surgeon. In spite of that,
he has an important place in the history of medicine.

Celsus was largely influenced by the Hippocratic

thought, but his de­scriptions of surgical practice
reflect a much higher level of accomplishment,
including the use of the ligature and performance of
the cataract operation. The richness of Celsus in
dermatological details is still reflected in present-
day dermatological nomenclature.
 Celsus was never mentioned by ancient
physicians and he became famous only during the
Renaissance, about fifteen hundres years after his
death. He wrote an encyclopaedic work, called De
re Medicine in Latin and mentioned different
subjects such as philosophy, military
administration, agricul­ture, code, medicine and
pharmacy.

We know that this broad encylopaedic work has

8 vol­umes . Pope Nicholas, the V th (1397-1455)
found this work for the first time and so, the manu­
script was printed and was published in Latin in
 It was also translated into English by J. Grieve in
1756. The first two of the known 8 volumes
mentioned agriculture and foods and the other six
of these volumes, medicine and drugs. The third
volume mentions fe­vers, the fourth volume realizes
internal diseases from head to toe.

The fifth volume is con­cerned with drugs and

dressings. Moreover, the sixth volume realizes the
five senses and vene­real diseases and the seventh
and the eight volumes investigate surgery .
 Andromaque I'Anciene (The first century A.D)
was also an important physician of Rome. Romans
called him, old Andromaque in order to distinguish
him from his son, young Andromaque.

He was the physician of Emperor Nero (54-68

A.D).According to rumors, he was the person who
added the flesh of snakes, opium and squill to the
composition of theriac. Theriac is a preparation that
was made from various drugs and was used as an
antidote in the ancient ages.
 Pline I’Ancien was born in Rome in Italy, he
became a military doctor at first and then he studied
science. He died in Pompei where he made
scientific experiments. Although he wrote many
works, all of them had been lost. But, one of them
was found and this book was suffi­cient enough to
make Pline immortal.
This publication was the History of Nature which
he wrote by resorting to about 2000 main sources. It
was a large encylopaedic work and had 37 volumes.
Later on, medical parts of this work were
summarized and the medicine of Pline was written.
 
 Galen (130-201 A.D) was well known as Calinos
among Moslems. His father was an archi­tect. He was
born in 130 in Pergamum in Asia Minor, the site of a
famous temple of Aesculapius. For nine years, Galen
studied medicine and phlosophy in Smyrna, Corinth
and Alexandria.
Then, be returned to his home town to become a
physician to the gladiators. Moreover, he became the
body physician of the Emperor-Philosopher Marcus
Aurelius. Galen died in 201. An extremely fertile
author, he wrote at least a hundred treatises. Charles
Daremberg (1817-1872) collected these works and
translated them into French.
 Galen was a first rate anatomist and physiologist
and with him medicine took a great step forward. In
the Hippocratic writing, medicine remained
essentially as an art. With Galen it be­came a science
often a deficient science.

Galen was a great dissec­tor and made great

advances in the knowledge of muscles and bones,
though less so in that of vessels, nerves, and viscera.
He described the brain and, its ventricles and placed
the medulla as a part of the brain.
 
 He showed the difference between sensory and
motor nerves, which he called soft and hard nerves.
Galen was even more outstanding as an
experimental physiologist.
 Galen was a modern scientist. He built up a wide
speculative system of physiology, This system is
most fully expounded in his treatises On the
Faculties and On the Use of the Parts. His most
famous physiological theory is that of the blood
flow, which domi­nated medicine up to the time of
Harvey.

According to this theory, the nutritive substances

were carried from the intestines into the liver, where
the natural spirits transformed them into blood. Part
of this blood flowed by way of the veins directly
into the periphery.
 The rest went into the right ventricle of the heart,
from which a small part moved into the lungs,
while the re­mainder passed through pores in the
septum into the left ventricle.

In the heart the blood was endowed with vital

spirits (entering through the lung) and carried
through the arteries into the periphery again. Some
of the blood reached the brain, where the animal
spirits were developed and dispersed into the body
through the nerves .
 Galen was interested in diagnosis as well as
prognosis. In "On the Affected Parts", he made an
important step toward local pathology. Galen tried
to distinguish between abdominal pain caused by
kidney stones and pain caused by an infection of the
intestines.
The measurement of the pulse and inspection of
the urine played a great role in his diagnostics. He
was addicted to polypharmacy; sometimes as many
as twenty five drugs were used in one prescription,
and such complicated prescriptions were henceforth
called Galenics.
 
 Thus, theriac was developed by Galen in the
ancient ages. Galen was very much concerned with
hygiene and stated in a rather modern fashion that
prevention is preferable to treatment.

Moreover, the medicine of Galen also depended

on the theory of external effects instead of the
theory of organism of Hippocrates or the theory of
four humors.
 
 Medicine of Rome that always regressed after
Galen, entirely declined in the period of Byzantine.
Oribasius (325-403 A.D) is from Pergamum. He
studied medicine in Alexandria.
He wrote an encylopaedia of 70 volumes and 10
volumes of this book were related to medi­cine.
Oribasius added a number of novelties to the ideas
of Galen.
 The biography of Paulus of Aegina (625-690) that
Moslems called Folus are not clear. He studied in
Alexandria. He was both a famous surgeon of that
period and a physician. There were seven works that
were attrib­uted to him.
These were about hygiene, febrile diseases,
external diseases, qualification of the diseases,
wounds, bites, surgery and treatment. These seven
works of Folus were translated into English in 1847
and they were published by Sydenham Society in
London .
   THERIACS IN THE HISTORY MEDICINE

Theriac has been used for the treatment of various

diseases since antiques ages. It is an electuary type
of preparation. Opium was one of the ingredients of
theriac in the ancient codexes. Because theriac was
used as a hypnotic as well as an analgesic.

Today, the drug con­tains very few ingredients, but

it still has an important place in folkloric medicine.
 Theriake, originating from the Greek word
Theriakos, means wild or poisonous animal. A
Greek doctor-poet, Nicander used this word for the
first time in 190-130 B.C. Nicander's poem
Theriaca is based on the stinging and biting of
poisonous insects and animals, and their treatment.
 The composition of theriac is mentioned and
explained in the poem: wild thyme, trefoil seed,
anise, fennel and parsley are kneaded with wine and
made into losenges. Another poem of Nicander is
Alexipharmacee in which Nicander talks about the
treatment of poisons.
Theriac was first used against the snake bitings,
later became an antidote against poisoning and
afterwards a speciality for all kinds of diseases. The
word Theriac (Tiryak) was also used in the Turkish
language as Teyrek, Tiyrek. The work Tiryaki
(addict) was derived from the word Tiryak.
 The interesting history of Theriac goes back from
the Roman Age. Poisoning was a very popular way
of killing poeple at that time. So, King Mithridate
IV of Pontus (120-63 B.C) pre­pared an antidote
against poisons, from various drugs. He called this
preparation Mithridaticum.
As it is recorded 54 drugs were used in the
composition of this medicine. Twenty leaves of rue,
some salt and two figs were the main ingredients of
the mixture. But, af­ter the Roman conquest of
Pontus, some changes were made in the
composition of the theriac.
 Some authors mentioned several compositions of
Mithridaticum. For example, Zopyrus (80 B.C)
found a different formula for theriac, frankincense,
white pepper, cinnamon, saffron, myrrh, spikenard,
boiled honey and wine are mixed. He called this
mixture Ambrosia.
 
A very different kind of Mithridaticum was
prepared by Neron's physician, Ancient
Andromaque (37-68 A.D). This mixture was so
famous, that it was listed in the pharmacopoles. It
was made up of 74 different drugs. Camphor, myrrh
and saffron made up the majority of the ingredients.

This preparation was used against the bites of

poisonous animals and asth­ma. It was even used
against colitis, jaundice, kidney inflammation,
plague. This medicine was prepared by the
physicians of the palace and was sold to the
pharmacists.
 A famous Roman physician Celsus (3-64 A.D),
in his De re Medicina, talks about theriac and says:
"Theriac is used against food and alcoholic
poisoning as well as some skin troubles". He
himself prepared theriac with 37 drugs and used for
the purposes mentioned.
 According to Roman physician Galen (130-201
A.D), this preparation is spesicifically used for
snake bites. Galen was ordered to prepared theriac
by the Roman Emperor Marcus Aurelius with 100
different ingredients including honey and wine.
 These early formulas of theriac were later used
during the Middle Ages by the Christian world. But,
those formulas were enriched by the addition of the
plants which were grown in the garden of
monasteries and by the powder of some precious
metals and jewels like gold, pearl and emerald.

According to a IX th century Anglo-Saxon

manuscript, theriac was used in England during that
century. Theriac was used by some English Kings
too. A theriac box which was believed to belong to
King Henry (1106-1125), is a good proof of this
belief.
 Cairo was the center of theriac preparations
during the second half of the Middle Ages. At the
end of the XIII th century, some Italian cities like
Venice, Florence and Genova started to prepare
theriac, too. The composition of Venetian Theriac
was similar to Andromaque Theriac. It was made up
of 73 ingredients and was supposed to be a valuable
medicine.
The wrapping of the medicine, which was a thin
paper contained information about its use. From the
informa­tion on the wrapping papers we understand
that theriacs were specifially used against insect
bites and poisoning. It was sometimes used for the
 Avicenna (980-1037) of the medieval Islamic
World, refers to theriacs as the most useful
composed drug in his famous work, Canon.
According to Avicenna, the medicine is used for
snake and scorpion bites, epilepsy, leprosy, enteritis,
asthma, liver and spleen diseases. Avicenna himself
made different theriacs for diffesent diseases.
These are known as Tiryak-i Sagir and Tiryak-i
Kebir and their compositions are different. The
ingredients first are ground, sifted and kneaded with
honey and wine till it becomes an electuary. This
electuary was kept in a silver or tin pot.
 An anonymous medical book, belonging to the
XV th century, mentions theriac as a drug used for
all kinds of diseases.

The book contains a formula to be used against

the poisons of animals: "A handful of century
flowers, a handful of rue and a little garlic are
ground together. This mixture is put on the bite.
This mixture can also be mixed with theriac and can
be drunk.
 
 The same book has another formula for
expectorant: "Some ferrosulfate is mixed with three
spoonfuls of water. The water is heated and given a
colour saffron and is drunk before it cools.

Some theriac should be taken immediately after

this medicine." Theriac was used for bullet
wounds in the XV th century Europe. A German
writer Hieronymus Brunschwig (1450-1533)
advocates theriac for bullet wounds.
A XVI th century English doctor, William Turner
said that a kind of theriac (Theriaca Andromachi)
was used anthelminthic and that it could be used for
muscles, liver, brain and spleen diseases. Another
kind of theriac, Confectio Raleighana, which was
prepared by a French pharmacist, Le Febre and was
listed in the English Pharmacopoeia of 1721. Le
Febre used 40 ingredients for this theriac and made a
maceration with the addition of wine. To this
maceration liquid, he added sugar, antimony,
calamint, ambergris, the powder of bucks' horns and
fig (2).
 
 These examples prove that Europeans had a great
confidence for theriac throughout centu­ries. This
confidence lasted until the public found out that
many precious ingredients were missing in the
composition.

Dr. William Heberden (1710-1801) made a study

of threiacs and he published the results in 1745 as a
report "Antitheriaka".
 Dr. Heberden studied all kinds of theriacs coming
from Mithridales to those of XVIII th century. He
found out that the anti­dotes, which had been found
in King Pontus room after his death, contained only
20 rue leaves, I salt grain, 2 nuts and 2 dried figs.
With this study, he proved that these medicines had
no value or medical effect.

In this report, Dr. Heberden wanted theriac to be

taken out from the English Pharmacopoeia, but this
proposition was not accepted and theriac remained
to be a popular medicine.
 68 ingredients' names and their quantities are
registered on the 397 th page of the 1837 French
Codex. To 68 ingredients, Cyprus terebinthine,
honey and Spanish wine are add­ed. Theriac is
registered in the 1866 French Codex too.
 In both codexes the composition of theriac is
related to the ancient Andromaque Theriac. Theriac
is not included in the French Codexes after 1866.
But, this did not affect the popularity of theriac and
poeple kept demand­ing and using it in the XIX th
century, too.

People took the trouble to travel to find a piece of

theriac. Even, a famous French physiologist, Claude
Bernard (1813-1878) insisted that the most
favourable material of the age was theriac.
 After studying the development of theriac from
the Antique Ages to the Renaissance, a dis­cussion of
its development in Turkey might be in order.
 
Theriac entered Turkey through Venice and it is
known as Mesir among Turkish people. Mesir is
derivated from King Mithridate's name. Mesir was
first made by Merkez Muslihiddin Efendi who was
the head physician of the hospital in Manisa. This
hospital was founded by Sultan Suleyman, the
Magnificent in memory of his mother Hafize Sultan,
in 1539.
 There was a wide demand for Mesir by sick and
healthy people alike, 41 different drugs were crushed
in mortars then boiled in big pots with sugar.

This electuary was wrapped in pa­pers and thrown

to people from the minarets of Sultan Mosque or
from the domes of Hafize Sultan Hospital. The
people believed that Mesir had protective power
against poisonous in­sects and it was given as an
appetitive and excitative drug.
 The tradition of throwing Mesir to people
continued till 1925. This ceremony was not held
from 1925 to 1952; in 1952 it restarted. Today, the
ceremony is financed by the Foundation, But, the
number of the ingredients of Mesir is only twelve.
 
 After the 16 th century, theriac was imported to
Turkey although Mesir was available. According to
the custom registers of 1816,one of the imported
medicines was theriac. In the meantime, some
kinds of the theriac were made in the palaces for
the Sultans. Among them are Macun-u Tiryak-i
Erbaa, Tiryak-i Semaniye, Tiryak-i Otuzkar.
Tiryak-i Askeri.
 
 Due to the great demant, theriac was sold by the
famous apothecaries of Turkey. So, theriac was also
sold in the XVI th century Edirne pharmacopoles.
In the XVII th century pharmacopoles, we find
three kinds of theriacs; These were Ana-Kiz Tiryak
(Mother-Daughter Theriac), Altinbaş Tiryak
(Goldenhead Theriac) and Kartal Tiryak (Eagle
Theriac).
 
 Turkish medical manuscripts mention theriac after
the XIV th century too. There is various
information about theriacs in the famous Islamic
physician, Mecusi Ali bin Abbas' Arabic work,
Meliki. or Kamil al-Sinaat al-Tibbiye. The XV th
century poet and physician Ahmedi's work. Tarvih
al-Ervah also includes some information about
theriac.
 The chief physician of the palace of the XVII th
century, Salih bin Nasrullah wrote: "In the case of a
snake bite, the bitten area should be cut and sucked.
After theriac is dissolved in vin­egar, should be
applied on its. For scorpion bites, Tiryak-i Erbaa
should be applied. For spider bites, the patient
should be induced to vomit. After vomiting, the
patient should drink some theriac. Theriac can be
used for hydrophobia dog bites, too."
 There is information about theriac in the V th
part of Omer Sifai's translation of Th. B.
Paracelsus' , Cevher al-Ferit ft Tib Al Cedid which
was written in the XVIII th century.

A Turkish translation (1874) of the 1866 French

Codex, Dusturu’l Edviye, mentioned a theriac
composed of 58 drugs. If terebinthine, honey and
wine are added, the number reaches 61. The
preparation of this theriac is as follows: Drugs are
blended altogether, ground into powder and sifted.
 The powder is called Theriac Powder. 1000 gr. of
theriac powder is added into 50 gr. of warm Cyprus
Terebinthine and blended. 3500 gr of melted, hot
honey is blended into the mix­ture. The rest of the
theriac powder, 250 gr. Malaga Wine are gradually
added to the mixture. After the mixture becomes a
homogenous electruary, it is put into big clay pots
and left there to dry. The dried medicine is crushed
in a mortar and used.
 In one of his works, Dr. Mehmed Nuri Bey (XIX
th century) describes theriac as a tranquilizer and
stomachic electuary which can be taken 1-4 gr.
daily.

Theriac is still made in our country by the

pharmacopoles. During the researches we made in
Istanbul we found that each pharmacopole has his
own way of preparing theriac, but none of them use
more than 10 drugs for it. Some anise, some cloves,
some senna, cinnamon, ginger, galangale and
limeblossom are mixed.
 They are boiled together and drained. In order to
hide the bitter taste of this boiled mixture, sugar is
added until it becomes as thick as syrup. Theriac
prepared in this way is put into small bottles and
sold.
Theriac is used for variety of purposes in
folkloric medicine. It is used against anaemia, the
bad odors of the mouth and to increase appetite.
Some mothers give theriac to their children to put
them to sleep. In the meantime, it is externally used
againts mumps and erysipelas.
 Prof. Dr. N. Oktel writes that theriac contained
many drugs and it could be used for pains and
enteritis. This drug is hemostatic and appetizing.
 
 Some ancient Turkish codexes mention that
theriac contains opium in its composition. In order
to find out whether today's theriac contains opium
or not, a specimen taken from the Egyptian Bazaar
was analyzed at the Institute of Pharmacy and
Technology of Pharmacy Faculty of Istanbul
University. No trace of opium was found.

The reason for theriac’s being used as a hypnotic

by the people is psychological.
 
THE SYMBOL OF SNAKE IN MEDICINE

Each one of the cities had a totem in

Mesopotamia and these Gods were represented by
an animal. The symbol of God Ningiszida was
double snakes wrapped a round a staff in the XXV
th century B.C.
The symbolizing of Gods and cities by animals
was also a tradition in other an­cient civilizations.
For example, the biggest one of the temples that
was founded for the sake of chief-God, Oziris in
ancient Egypt was in the city of Tebh. Thus, the
symbol of this city was also a snake.
 The mother Goddess of Iskit, Tabiti,was thought
as in the form of semi-man and semi-snake. The
demon that caused some diseases, especially
psychiatric disorders, was symbolized in the form
of a snake in ancient Israel.

The snake was also the symbol of Aesculapius.

Thus, the serpent on the gate of Aesculapius'
hospital has remained as the symbol of medical
science up to the present day.
 The symbol of the snake spread extensively from
here to Western and Eastern countries and it
showed different developments. For example, the
snake had an important place in an­cient India and
in Persia.

It is said that the snake, especially double

snakes became the symbol of happiness among the
Middle Asian Turks. For this reason, double snakes
were symbolized on the emblems of kings, on
temples and on entrances of foundations of health.
Turks that mi­grated from Asia, brought this symbol
to various areas, including Anatolia.
 The symbols of double snakes were carved on
the stones on the gates of Seljukian hospitals that
embellished Anatolian cities. Thus, double snakes
that were remainders of Seljukians, were the
symbol of medicine of the emblems of medical
persons in our country until 1938.

The snake is also found in the emblems of

pharmacists, dentist and veterinarians. But, these
are different from the rosettes of physicians.
 So, the snake has become the symbol of
physician-ship since ancient ages. The shedding of
the skin of snakes symbolize the youth or rather,
this situation explains that physicians should renew
their knowledge all the time.

Thus, this phenomena is interpreted by almost all

primitive societies as the snake’s casting of old age
and the beginning of rejuvenation. Because of
shedding its skin, the snake achieves immortality.
 Moreover, snake meat was used as a drug in
the ancient ages. A snake is also careful and
cautious animal. So, a physician should also be a
careful man in his profession . 
The snake has been the symbol of medicine
since antique ages for all these reasons .
 
The four humors and the four elements.