IN GOOD HUMOUR

“In nothing do men more nearly approach the gods than in giving health to men.” - Cicero

I had a meeting with my publisher today and we discussed a project of mine concerning a book to come out next year. In our discussions we started talking about the history of medicine and more specifically we talked about the ancient humoral theory of disease. This was a philosophy that originated with the ancient Greeks and which aligned the four “elements” (earth, fire, water and air) with the four body fluids or “humours” (blood, phlegm, black bile and yellow bile). The importance of this system of medicine in history cannot be stressed enough as it held sway for many centuries before it finally gave way to the new ideas heralded by the Renaissance and which took over in the age of enlightenment.

The four elements was an attractive theory, because it seemingly explained how all things were made up. If one took wood, for example, it was full of water when fresh and one had to dry it to remove it. When one heated it, it was set alight, liberating its content of fire and ultimately, as the air was driven out of it in the form of smoke, ash would be left behind as the last component, earth. Different things were made up of different proportions of earth, fire, air and water, accounting for their different textures and properties.

Similarly, the four humours of the body made up the flesh and fluids. When one was healthy, there was a good balance of these humours. We still speak of someone being “good-humoured”. There are disorders of the blood that the haematologist still refers to as “dyscrasias” – literally a “bad mixture”.

An excess of blood made the person “sanguine” or “plethoric” and these people tended to be obese, but also robust and active, moderately hypersexed with a good appetite and a full strong pulse. The way to treat them was to bleed them, relieving them of their excess of blood! Many poor patients were bled to death by the overzealous ministrations of their physician. A sanguine person nowadays still describes someone cheerfully optimistic.

Too much phlegm made the person “phlegmatic”: Flaccid and obese with thin hair, narrow blood vessels and white pasty skin. They were said to be slow in movement and intelligence, even-tempered and not given much to gastronomic or sexual pleasures. We still use the word rather disparagingly to describe someone who has an unemotional and stolidly calm disposition.

Having too much black bile in your body made you “melancholic”, which term has been retained in the language to describe someone who feels sad, gloomy, or depressed. In humoral medicine the melancholic type was usually, dark, hairy, with narrow blood vessels, slow pulse, large appetite and inclined towards excessive sexual activity. Quite often these people were purged with powerful drugs or herbs in order to rid the body of the excess humour.

The last humour yellow bile, in excess, made someone “choleric” (meaning today bad-tempered and irritable). This type of person tended to be thin, energetic, with a strong inclination to sexual pleasure, fastidious of food, a strong rapid pulse and good blood vessels. Emetics were prescribed to rid the body of the yellow bile which was in excess (an obvious in the vomit brought up!).

Around about 450 BC, the Greek philosopher Empedocles developed the theory of correspondence between the four elements with the four bodily humours and described disease in terms of imbalances between the elements and the humours. Unfortunately, this philosophically attractive theory which was not based much on fact or supported by experiment became the dominant theory in medicine, influencing many Greek and Roman medical schools, Islamic medicine and subsequently European medicine well into the Renaissance.

We no longer think there only four elements, and we know precisely what makes up the body and it’s not four humours. We know about disease, its causation, its diagnosis and its treatment. However, it is amusing that even in this day and age we retain the antiquated terms of the humoral theory even in our common language…