When you don’t have the slightest notion of germ theory, the benefit of X-rays and microscopes, not to mention an extensive (and modern) knowledge of chemistry, biology and anatomy, you have to use what you know and observe to try and figure out how the body works – and therefore how to get it better when it goes wrong. For thousands of years illness was blamed on acts of the gods, or magic, but as mankind began its first tentative pokes into science and observation, other theories (not involving supernatural causes) were developed.
It was a Greek philosopher and scientist, Aristotle, who first proposed that everything in the universe was made up of five elements: earth, air, fire and water and ether (spirit) – although there are suggestions that his knowledge may have come from ancient Egypt. He gave properties to each of these elements so that earth was cold and dry and had the properties of a solid, whereas water was cold and wet and corresponded to a liquid. And if everything else was composed of elements, then obviously so was the human body (although ether is not mentioned in this capacity). Hence if a body was made up of earth, air, fire and water, it was also made up of their properties, and for it to be healthy all of these properties (or humors) had to be in balance. If one humour somehow managed to get out of control it cause disease and temperamental issues in a person. Each humour was also associated with a bodily liquid, as it was observed that when a person was unwell, it often came out in the form of some sort of liquid such as blood or phlegm – and it was deduced that the person then had an excess of that liquid in the body, and therefore the associated humour.
Hippocrates and Galen followed and developed these principles further (although they are often credited with starting it off, not Aristotle) and the theory of the four humours became the basis of Greek medicine. In fact humourism was so well accepted it continued through the Roman and medieval eras right up until the mid 1800s.
Medieval physicians would take an observation of a person’s humours into consideration at diagnosis and the cure would be based upon correcting any imbalance. Therefore is a person was tending to the cold and moist, they might be directed to eat spicy foods, as these had a warming effect. Of course today this theory has been superseded by modern medical practice but, even though much of what was believed could be considered as rubbish today, there are still some things that have some truth in them. Using the example above, if someone today has a cold (considered moist and cold), then spicy foods are often recommended to raise the body temperature and ‘sweat’ the cold away.
Anyway, time for a diagram to try and make things a bit clearer:
The four types of liquid were also associated closely with temperament and gave their name to the four temperaments – which became interchangeable with the humours (hence the saying that someone is in good – or bad – humour). Therefore if a person had too much choler (yellow bile), he was said to be choleric (and had all the properties concerned with choler including being hot and dry, and full of fire). If he had too much black bile, he was melancholic. The four humours were believed to arise in the body, according to Galen, anyway, and in the liver in particular. Their waste products were eliminated via the bile, urine and sweat.
This was considered to be the first to be produced in the body and as such it received a greater share of nutrients. Warm and moist, it carried the vital energy of the body producing health and growth. It was associated with the season of spring and someone who had a sanguine temperament was said to be full of optimism and energy.
Phlegm was the next liquid to receive a good share of nutrients and as such was also vital to bodily health. This category didn’t concern only phlegmy mucous (yeuch!) but also all other clear bodily fluids such as saliva and lymph. Cold and moist, its properties helped with keeping the body lubricated, cooled, wet and purified. Its watery quality meant that it had a large part to play in expulsion of bodily wastes and impurities. A phlegmatic temperament was calm, thoughtful, caring and reasonable.
Choler, or yellow bile was associated with fire and as such was considered to be of a caustic nature. Needless to say, unlike blood and phlegm, the body needed less of this humor to stay in balance and function. With too much choler a person might suffer from inflammation and digestive disorders. A choleric person also tended to anger, egocentricity and an overbearing nature. On the plus side, choleric people had a restless ambitious energy and were often considered to be natural leaders.
Melancholic Humour – black bile – earth – autumn (cold and dry)
Black bile, like choler, was necessary for the body, but not in large amounts. Its purpose was to consolidate and to retain and thus was essential for the development of bone and teeth – as well as solid stools (poo). It helped to clot the blood and form scar tissue. Too much black bile however could lead to blockages within the body as well as a temperament prone to depression, seriousness and cautiousness.
So, as you can see, the humours needed to be in balance, although not necessarily in equal amounts. Blood and phlegm were the most plentiful in the body but yellow and black bile were also vital in small amounts
The next question is, how did the humours get out of balance? The medieval medical model adopted from the Greeks maintained that it was a matter of lifestyle, particularly diet, that affected the bodily equilibrium. A diet too rich in meat, for instance, produced excess yellow bile while a lazy lifestyle was indicative of too much black bile.
Things that could affect the humours
Of course, this is only the simplest overview of one part of medieval medicine – but it is a rather important part as it played a huge part in the diagnosis and treatment of illnesses. Talking of diagnoses, that will be the subject of the next post: how a physician actually found out what he thought was wrong with you.