Paul of Aegina was the last of the physicians of
the Byzantine culture to practice in Alexandria,
which fell to the Arabs in his professional lifetime
in 642AD. He refers to both mithridatium and ther-
iac. Paul of Aegina was a link between Greek med-
icine and Mohammedan medicine. His book was
used by Rhazes (854–930AD), one of the greatest of
the Arab physicians. Avicenna (980–1037 AD)
approved of mithridatium as an antidote to poisons,
and Maimonides, a Jew born in Moslem Spain,
was also familiar with mithridatium. Mithridatium
re-entered Western medicine culture by two routes.
A Saxon leechbook of the eleventh century records
that Abel, the Patriarch of Jerusalem, sent mithrida-
tium or theriac to King Alfred the Great, who died
on 26 October 899 (Stenton, 1947).
TheLeechbook of Bald(Rubin, 1975)is the most
important piece of medical literature to have sur-
vived from the Saxon period. The document is in
two parts or leechbooks; the first contains 88 chap-
ters and the second 67 chapters. They were written
circa 900–950ADfrom an earlier ninth century
Latin text. Following them is a third book, consist-
ing of 73 sections, written in the same hand, but
which is nevertheless a separate and additional
work. It, too, is of similar age and likely to be a
copy of earlier material. A verse at the end of the
second leechbook suggests that these books
belonged to a physician or leech called Bald, and
were written down by a scribe called Cild. These
three leechbooks were obviously intended as man-
uals of instruction for the treatment of a variety of
illnesses, injuries and mental states, together with
instructions for the preparation of herbal mixtures.
Interspersed with these remedies are sections deal-
ing with rites, charms and invocations. Christian
and residual heathen practices are represented, the
latter including Greek and Roman traditions in
addition to Germanic and Celtic folklore, which
the Saxons had either brought with them from their
homeland or found persisting on their arrival in
Britain. There can be no doubt that these leech-
books were intended to be consulted in the physi-
cian’s everyday practice. Certain phrases and
remedies can be traced to classical times, for exam-
ple the sixth century Alexander of Tralles, and the
fifth century Marcellus Empiricus. A most impor-
tant passage is contained in the second leechbook
and concerns King Alfred. It refers to his request
that the Patriach Elias of Jerusalem send him reme-
dies which the prelate had found to be effective. A
theriac formulation appears in this leechbook.
The second route was when the works of the
Greek and Roman medical writers again became
available in Italy, possiblyviaSpain or through the
university at Salerno. Theriac appears to have been
more greatly favored than mithridatium as a
remedy for poisons. In the twelfth century, theriac
was being manufactured in Venice and widely
exported. In England it became known as ‘Venetian
treacle’ (‘treacle’ is a corruption of theriac). Ther-
iac became an article of commerce, with Venice,
Padua, Milan, Genoa, Bologna, Constantinople
and Cairo all competing. The manufacture of
these theriacs took place in public, with much
pomp and ceremony.
It was commonly thought by those in authority
that if mithridatum or theriac did not produce the
desired cure, this was due to incorrect preparation
(perhaps with adulterated or poor-quality materi-
als) or to incorrect storage after use. As the only
cause for therapeutic failure therefore lay with the
pharmacist who compounded the mixture, the
remedy lay in careful scrutiny of manufacture,
which should be in public. Any misdemeanor
should then be detected and immediately punished.
The earliest written code of quality control in
Britain seems to be theOrdinances of Guild of
Pepperers of Soper Lanein 1316. The Pepperers
in the twelfth century took over the distribution of
imported drugs and spicery (which includes spices,
sugar, confections and fruit). They were not always
easy to distinguish from the Spicers, who them-
selves became intermingled with or perhaps suc-
ceeded by the Grocers. TheOrdinancesof 1316
possibly included the Apothecaries and the Spicers
andforbade themixingof wares ofdifferentquality
and price, the adulteration of bales of goods or
falsifying their weight by wetting.
For the next several hundred years, the story is a
confused one, containing the roots of the later
separation of the Apothecaries as a craft guild
and their emergence, first as compounders of med-
icine and then as a division into those who ulti-
mately became general medical practitioners and
those who, together with the emergent chemists33.1 THE EVOLUTION OF HUMAN MEDICINES CONTROL FROM A NATIONAL TO AN INTERNATIONAL PERSPECTIVE 417