humours

humours For over 2000 years Western medicine and culture perceived the body and the mind in humoral terms. Some of the Hippocratic writers (c.450–350 bc) developed physiological and pathological theories centred on the belief that the fluids in the body were its most significant constituents. In the Hippocratic treatise On the Nature of Man, blood, phlegm, yellow bile, and black bile were listed as the four humours or fluids, and these became the canonical four humours (early on water was considered a humour, but black bile replaced it). Blood and phlegm were clearly apparent, yellow bile was found in the gall bladder of animals and showed itself in jaundice, and black bile, which was supposed to be the heavier part of the bile, manifested itself in conditions where the skin became black.

Greek physicians came to believe that health occurred when the humours were in balance and illness when they were out of balance. The latter happened when there was an excess of a humour, or if a humour took on an abnormal quality — if, for instance, it became putrefied or too hot.

The relationship of humoral medicine with Greek natural philosophy was formalized by Galen (129–216 ad). He wrote that the four humours were made up of the four qualities: hot, cold, dry, and wet. These qualities had been used by Aristotle (384–22 bc) as the building blocks of the four elements: earth, water, air, and fire, with which he explained the material nature of everything on earth and below the moon. The humours of the body and the elements of the physical world thus shared a common qualitative nature, and the microcosm (the little world of the human body) and the macrocosm (the greater world) were related to each other.

The qualitative theory of humours and elements is shown diagrammatically in the figure.

The diagram shows, for instance, that the combination of hot and cold produces the element of air and the humour of blood. Blood predominated in spring, and a person with a natural excess of blood would have a sanguine physical and psychological humoral constitution, or temperament. In Greek medicine, physical and psychological aspects were believed to be causally interrelated, so the four constitutions expressed both physical and behavioural characteristics.

health and illness were conceived in terms of the overall balance of the humours and qualities, the idea of balance reflecting the Greek praise of moderation in all things. Therapeutics was concerned with restoring the equilibrium or healthy mixture of the humours. An excess of a humour could be eliminated by bleeding, purging, vomiting, or sweating, as could also a vitiated or unhealthy humour. Attention to diet, exercise, and other aspects of a patient's lifestyle would preserve a balanced constitution or restore it. Specific remedies — mainly based on herbs, though some minerals were also used by Greek, Roman, European medieval, and Renaissance practitioners — were employed on allopathic principles. It was believed that ‘opposites cure opposites’, so a cold remedy could cure a hot illness. Herbs and other drugs were given degrees of heat, moisture, etc. based on a sensory subjective assessment from one to four; this was especially popular in the Middle Ages and the Renaissance.

The humoral system was holistic. Illness was perceived as an internal disorder of the whole body, rather than being the result of specific external agents of disease such as bacteria. However, the external, visible world was deemed to affect the body. Geography and climate shaped a nation's as well as an individual's humoral constitution. The Hippocratic treatise Airs, Waters, Places asserted that the races to the North of Greece were hardy and tough, whilst the Egyptians were soft, living as they did in a climate with little change and posing no hardships. The outside world and a patient's response to it, seen in their lifestyle (diet, exercise, the emotions), were viewed by Galenic physicians as key determinants of health. Humoral medicine related to the individual patient rather than to the disease. Each constitution was different — though lying within the four categories of sanguine, phlegmatic, etc. — for the circumstances that shaped a constitution varied with each patient. Advice on regimen and on treatment had to take into account the particular patient's constitution, lifestyle, and environment. In this way, humoral medicine was tailored to the individual. Not surprisingly, it was an expensive form of medicine, as, in theory at least, the practitioner had to spend a good deal of time listening to the patient's story and assessing his or her circumstances. A cheaper form of medicine was provided by practitioners who treated the disease rather than the patient, and who gave the same treatment to everyone suffering from the same disease. This was the practice of the empirical group of doctors whom Galen attacked for ignoring the patient, and for using the results of trial and error as the basis of their therapeutics. In the Middle Ages and the Renaissance, the ‘learned physicians’ who were taught Galenic humoral medicine in the universities labelled such doctors quacks, empirics, and mountebanks.

The humoral vision of the body lasted until the late seventeenth century in Europe. Then the ‘new science’ of Galileo, Descartes, Newton, and Boyle replaced Aristotelian qualitative natural philosophy with a mechanical, chemical, and mathematical vision of the world and of the body. Humoral medicine retained some influence in the eighteenth century. Therapeutic measures such as bleeding and purging, designed originally to get rid or excess or malign humours, continued to be used. The language of the humours was still employed to characterize people, and melancholy, especially, was a major category of mental illness into which the well-to-do, the sedentary, and the studious were even more liable to be placed in the eighteenth century than they had been in preceding centuries.

Today, the humours live on in traditional Arabic medicine, which is based on Galen via the writings of Avicenna. In India, as well as Arabic medicine, there still exists the ancient humoral and qualitative system of Ayurveda. In the West, the bacteriological and technological revolutions in medicine of the late nineteenth and twentieth centuries have all but obliterated the humours from orthodox scientific medicine. Now the emphasis is on the disease and on parts of the body rather than on the whole person and their lifestyle. Holistic medicine, which for centuries had been associated with the humours, still exists — though largely bereft of humoral theory — as alternative medicine. The irony is that the medicine that focused on the disease rather than the patient, which had been derided by the past orthodoxy of learned humoral medicine as quackery, has become, after various historical processes, the established medicine of the West.

A. Wear

See also Galen; health; illness; medicine.