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Crises of Credibility: Galen’s Antidotes and Modern Immunization
by Alex-Jaden Peart
by Alex-Jaden Peart
May 29, 2026
Alex-Jaden Peart examines Galen’s On Antidotes to note the resonances between ancient prophylactic antidotes and modern vaccines. He argues that Galen’s focus on ingredient quality and preparation (sunthesis) can be a mirror or a contrast to modern misgivings and mistrust around biomedicine in the west.
Alex-Jaden Peart was the Society for Classical Studies’ 2024-25 Lionel Pearson Fellow. His MPhil thesis (Cambridge) studied contagion as a transhistorical paradigm of sympathy. He is currently a Fulbright Austria US Teaching Assistant and the incoming P.E. More Fellow in Classics at Princeton University.
When enumerating the most foundational milestones and breakthroughs in the history of biomedicine and public health, many come to mind: germ theory, contraception, blood transfusion, food safety, robot-assisted surgery, immunotherapy, the seatbelt, anesthesia, municipal treatment and filtration of water, and antibiotics. Yet, because two of them, as recommended by the Centers for Disease Control and Prevention (CDC), are typically administered within the first 24 hours of birth, vaccines hold an especially immediate and pervasive grip on the public conception of modern medical advancements. Thanks to vaccines, a host of life-threatening, once worldwide diseases—ranging from polio to smallpox and measles to meningitis—have been made available to eradication. Vaccines have been particularly influential in reducing infant and child mortality rates, with a reduction in mortality among the former falling by two-thirds from approximately 10% in 1974 to less than 3% fifty years later.
In recent years, however, there has been a growth in sentiment against vaccination practices by people referred to, often pejoratively, as “anti-vaxxers,” who tend to refer to themselves as “vaccine skeptics” or “anti-vaccination activists.” Though traceable all the way back to the earliest variolations in the eighteenth century, recent waves of anti-vaccination rhetoric can be linked back to a 1998 study published in The Lancet, a British medical journal, which causatively linked the measles, mumps, and rubella (MMR) vaccine and colitis to autism diagnoses. The publication has been disavowed since 2010, and its findings were both repeatedly and quickly disproven, but the damage has been done. The public must now grapple with the false narrative of causality between vaccines and the tragedy that is Sudden Infant Death Syndrome (SIDS), along with the reality of (albeit exceedingly rare) instances of vaccine-induced immunological and autoimmune adverse events. This tangled web has made it progressively more difficult for the American public to give due credence to established forms of expertise and authority. The result is that routine vaccine rates among children are in freefall.
Although the details of these debates are thoroughly modern, distrust and danger have long surrounded discourses about drugs promising immunity. Among Galen’s expansive texts about pharmacy, On Antidotes captures this history. In this text, Galen provides his own recipes for complex, compounded drugs (pharmaka) that treat a wide range of bites and poisons. As Galen defines it, antidotes can be sorted into three "distinct categories." As Galen states:
Portrait of Mithridates as Heracles, white marble, 1st c. C.E., Louvre, Ma 2321.
"Certain ones are employed, on account of deadly drugs; some are used because of wild animals specified as poisonous; some avert affections produced by poor regimen. Some themselves promise the three uses, like the one concocted by the physician Andromachus called “theriac” superseding the one called “mithridate” and so-called after its concocter.
This Mithridates, just like our Attalus [Philometor Euergetes III of Pergamon, 170–133 B.C.E.], was eager to have experience with almost all the simple drugs, as many deadly drugs as he set himself against, testing their capacities upon oppressed people, who had been sentenced to death. He discovered some of them peculiarly suitable in the case of venomous spiders, some on scorpions, just as others were on vipers. Regarding lethal drugs, some were efficacious against aconite, others against the sea-hare, and other antidotes upon others. After he mixed all these things together, Mithridates made one drug, hoping to come to possess an aid in all deadly affections." (Ant. 1.1 = 14.1–2 K.)
In this sliver of the translated text, Galen traces the practice of using antidotes back to King Mithridates VI Eupator of Pontus (135–63 B.C.E.), who developed an eponymous antidote (“mithridate”), a mixture of various deadly drugs, to slowly render him invulnerable to poisoning. This practice has come down to us under the name mithridatism, which, more colloquially, makes use of “hair of the dog” principles. As imparted by Pliny the Elder, Mithridates’s recipe was just one of the spolia opima taken to Rome in 63 B.C.E. (HN 25.3.6–7), when the Third Mithridatic War (73–63 B.C.E.) ended with the annexation of Pontus and the Seleucid Empire. There, the mithridate gained its more famous name when Nero’s archiatros Andromachus altered the existing recipe by making an inclusion of the flesh of a viper (thus thēr, “beast, wild animal”; cf. [Gal.], Ther. Pis. 5 = 14.232 K.). Theriac’s imperial consumption thereafter continued apace, with Marcus Aurelius and Septimius Severus imbibing the cocktail, while Commodus was a notable exception (Ant. 1.4 = 14.24–25 K., 1.13 = 14.65–66 K., 1.14 = 14.71 K.).
Galen recalls taking over the preparation (sunthesis) of Marcus Aurelius’s daily dose of theriac after the death of the archiatros Demetrius, with whom Galen had been acquainted. What is remarkable here is Galen’s casual mention of Marcus’s insomnia (agrupnos), as well as the symptomatic drowsiness (nustazein) from his chronic use of opium (khronizein), as well as its mollifying effects on his character. Galen’s version of theriac, we are told, did not cause such symptoms and was, therefore, highly valued (Ant. 1.1 = 14.4 K.). As we see, Mithridates and Marcus imbibed antidotes in the hope that they would render poisons entirely harmless (pantapasin ablabēs).
Bust of Marcus Aurelius, white marble, c. 166 C.E. Fondazione Torlonia MT 553.
Albarello vase for theriac, 1641. Public Domain.
Even by Galen’s lifetime, theriac had come to circulate among elites as a prophylactic, one laden with (sometimes exotic) ingredients. In Early Modern Europe, for example, such complex pharmaceutical concoctions remained in vogue, passing under names such as triaca, triaga, and triaha (whence English’s treacle). A 1683 recipe for the famed Venetian theriac (Theriaca andromachi) called for 64 diverse roots, stems, leaves, flowers, fruits, seeds, oils, gums, animal products, and minerals. It held the revered status of something miraculous in a way not entirely unlike vaccination did—and, for many, still does—in our time, steadfastly eradicating (or, at least, mitigating) disease after disease.
In what way are ancient antidotes like modern vaccines? Although Galen’s class of antidotes that are said to “avert affections produced by poor regimen” appears more aligned with the category of prophylaxis, or preventive healthcare, the mithridatism practiced by Mithridates and Marcus was part of a wellness routine designed to provide immunity against a wide array of dangers, including poisoning and animal bites. And, in functioning as a type of immunization, the antidotes are conceptually akin to our vaccines. Perhaps because they were taken prophylactically, without the persuasive force of a crisis, these drugs also elicited similar doubts about efficacy and trust.
Uğrak et al. (2025), “Themes and sub-themes of vaccine refusal.”
The misgivings surrounding vaccines are manifold, but a particular strand is material: What is inside this needle? What are its contents going to do inside my body? From where did the ingredients even originate? Published by BMC Public Health in 2025, a study carried out in Turkey found that a statistically significant reason for vaccine refusal and hesitance was a lack of knowledge in regard to drug composition, with participants balking at the presence of mercury (in the form of the preservative thimerosal) and “pig genes.” The latter mirrors the religious concerns that erupted in relation to the bovine origins of Edward Jenner’s 1796 smallpox vaccine.
In a way that echoes these modern anxieties about the quality of medicinal preparations, Galen is well-known to have been particular about the ingredients used in simple and complex drugs. This care is nicely shown in the case of cinnamon, which was a key ingredient in antidotes like theriac (Ant. 1.4 = 14.24 K.) and of which Galen lost a great deal in the Fire of 192 C.E. (cf. Ind. 3–6 = 3–4 Boudon-Millot, Jouanna, and Pietrobelli). As Galen tells it, the best cinnamon is “composed of fine particles” (leptomeres) and heats to the third degree (SMT 7.10.25 = 12.26 K.). Galen’s commitment to quality, genuine ingredients is evident from his peregrinations around the Empire, and, in the context of antidotes, we see this in his lament at the difficulty of discerning counterfeit varieties of Indian lukion (dyer’s buckthorn) and Lemnian earth (Ant. 1.2 = 14.8 K.). In her recent study of the ancient pharmacological trade, Laurence Totelin has shown the accusations of fraud, adulteration, and mercantilism leveled against actors in the trade, as well as how “hard” and “soft” consumers responded to these strategies.
Franz Eugen Köhler, Opium poppy (Papaver somniferum). Köhler’s Medizinal-Pflanzen, 1897. Public Domain.
As Ann Ellis Hanson has argued, the Greco-Roman pharmacological tradition was one largely dominated by conservatism, and Galen’s verbatim quotations from earlier treatises confirm that he esteemed the received tradition and especially its drugs, ones which “were known to [his] predecessors” (Opt. Med. Cogn. 11.7 = 122 Iskandar) and, ultimately, dokimon (“tested”, “well-reputed”, “trustworthy”). Indeed, as Galen relates, the recipes (graphai) for the most intricate pharmaka were often adulterated and corrupted, accidentally and not, by those copying and sharing them (Ant. 1.5 = 14.31–32 K.). Given the potential for variance, Galen made it a habit to collect at least two copies of the same recipe, as well as, as we have seen, to treasure the centuries-old pharmacological formulations that have stood the test of time (Comp. Med. Gen. 2.1 = 13.462–465 K.), combining “theory” (logos) and “testing” (empeiria, peira) to have done so.
Returning to our present, we may approach the distinctive feature of our pharmaceutical modernity through its doubly bound nature: on the one hand, its hallmark has been the marvel of rapid and reliable advances in pharmacology; on the other hand, that alacrity poses problems for the “wait-and-see” crowd, for whom the speed at which COVID-19 vaccines were released (and, subsequently, made mandatory for returns to work and school) was a cause for concern, despite the extensive clinical trials undertaken by Pfizer and Oxford-AstraZeneca before their respective vaccines’ distributions to the general public. Indeed, categorically false claims of COVID-19 vaccine-induced infertility, concealed tracking devices, and intention to harm communities found currency on social media, a study from Frontiers in Psychology discovered. Such discourses would have been unthinkable for the tradition of continuity comprised by ancient pharmacology.
Again, what to make of these disparities in the formation of immunology? The ‘evolutionary link’ among antidotes, variolation, and vaccines would be the idea that resistance qua immunity could be induced by a foreign, noxious agent. The ‘turning point’, like numberless and all too often taken-for-granted gifts of modern life, is safety and ease of access. The latter has been secured by the phenomena of globalization and capitalism. With the former, it is crucial to recall that mithridatism-cum-variolation was an incredibly dangerous activity. Our current privilege of potentially sore arms, nausea, and headaches being the main side effects of vaccines, while bothersome, looks like child’s play when compared to the life-threatening realities of ancient antidotes. One cannot help but wonder if those who oppose vaccinations would change their tune if they had a greater historical awareness of the experiments of the past—their success and failure—and how far we have come; indeed, how far we have yet to go.
Bibliography
Devinant, Julie. “Pathology,” in P. N. Singer and Ralph M. Rosen (eds.), The Oxford Handbook of Galen. Oxford University Press, 2024, pp. 323–341.
Hanson, Ann Ellis. “Papyri of Medical Content.” Yale Classical Studies, vol. 28, 1985, pp. 25–47.
Laskaris, Julie. “Galen’s Pharmacology in Context,” in P. N. Singer and Ralph M. Rosen (eds.), The Oxford Handbook of Galen. Oxford University Press, 2024, pp. 186–205.
Schlange-Schöningen, Heinrich. Die römische Gesellschaft bei Galen: Biographie und Sozialgeschichte. De Gruyter, 2003.
Singer, P. N., Matteo Martelli, and Lucia Raggetti. “Pharmacology: Texts, Theories, and Practices,” in P. N. Singer and Ralph M. Rosen (eds.), The Oxford Handbook of Galen. Oxford University Press, 2024, pp. 296–322.
Splendore, Barbara Di Gennaro. The State Drug: Theriac, Pharmacy, and Politics in Early Modern Italy. Harvard University Press, 2025.
Totelin, Laurence M. V. “Mithradates’ Antidote: A Pharmacological Ghost.” Early Science and Medicine, 2004, vol. 9, no. 1, pp. 1–19.
Totelin, Laurence M. V. Selling Pharmaka, Buying Health in Ancient Greece and Rome: Retail Therapy. Routledge, 2026.
Uğrak, Uğur et al. “Understanding the rise of vaccine refusal: perceptions, fears, and influences.” BMC Public Health, vol. 25, no. 2574, 2025, https://doi:10.1186/s12889-025-23754-5.
Additional Resources:
CDC. “Thimerosal and Vaccines.”
NPR. “The Anti-Vaccine Movement.”
Sheposh, Richard. “Unethical human experimentation.” EBSCO Knowledge Advantage, 2024.
Singer, P. N., and Ralph M. Rosen (eds.). The Oxford Handbook of Galen. Oxford University Press, 2024.
World Health Organization. “History of Vaccination.”
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