Humorism

• 1. Introduction

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  Humorism is the medical theory that ruled Western medicine for more than two thousand years, holding that the human body runs on four distinct fluids: blood, yellow bile, black bile, and phlegm. For all that time, doctors believed that every fever, every mood swing, every bout of melancholy came down to an imbalance among those four substances. Hippocrates, the Greek physician-philosopher who lived from 460 to 370 BC and is still called the "Father of Modern Medicine", built much of his practice around this idea. And Galen, who was born in 129 AD and died in 201 AD, extended it into a system so thorough and so authoritative that it would not be seriously challenged in the Western tradition until 1543. The theory was not definitively disproven until 1858.

  How did a framework so wrong hold on so long? What did it look like in practice? And what does it say about the way human beings have always tried to make sense of illness? Those are the questions this documentary will trace.

• 2. Deep Roots

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  The word at the heart of the whole system is "humor", a translation of the Greek word chymos, which literally means juice or sap and carries the secondary meaning of flavor. The word itself hints at the theory's ancient roots. Possible precursors exist in Ancient Egyptian medicine and in Mesopotamia, and early texts on Indian Ayurveda presented a theory of three or four humors, which practitioners sometimes connected to five elements: earth, water, fire, air, and space.

  The Greek thinker who first gave the idea serious philosophical shape was Alcmaeon of Croton, active roughly between 540 and 500 BC. His list of humors was longer and drew on the fundamental elements described by Empedocles, including water, earth, fire, and air. What Hippocrates did was pare that list down and redirect it toward bodily medicine. Where Alcmaeon was dealing in abstract elemental forces, Hippocrates pointed to specific fluids inside the body.

  Empedocles's influence continued to shape the system long after Hippocrates. Later scholars paired each humor with one of Empedocles's four elements and with a season. Blood corresponded to air and to spring. Yellow bile corresponded to fire and to summer. Black bile was tied to earth and autumn. Phlegm connected to water and to winter. This table of correspondences gave the theory a symmetry and an elegance that made it feel like a genuine map of nature, not just a medical guess.

• 3. The Hippocratic Framework

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  One of the treatises attributed to Hippocrates, called On the Nature of Man, spells out the foundational claim in plain terms. The human body contains blood, phlegm, yellow bile, and black bile. Health is the state in which those substances are in the correct proportion to each other, both in strength and in quantity, and are well mixed. Pain occurs when one of the substances presents either a deficiency or an excess, or is separated in the body and not mixed with the others.

  Alcmaeon and Hippocrates both held that an extreme excess or deficiency of any of the fluids could signal illness. Hippocrates and then Galen pushed further, arguing that even a moderate imbalance in the mixture could produce behavioral patterns. This meant that the theory was not just about disease but about personality. A surplus of blood produced a sanguine temperament: enthusiastic, active, and social. Too much yellow bile made a person choleric: ambitious, decisive, aggressive, and short-tempered. An excess of black bile generated a melancholy character. And those with too much phlegm were phlegmatic, meaning reserved.

  The Hippocratic physician described in On Airs, Waters, and Places arrived to an unnamed city and tested the wind, water, and soil to predict which diseases would appear there based on the season. Cities exposed to hot winds were seen as prone to digestive problems from excess phlegm. Cities exposed to cold winds were associated with lung diseases, acute conditions, and issues of the eyes and nosebleeds. Cities to the west were believed to produce weak and pale inhabitants. Environmental medicine, in other words, was baked into the theory from the start.

• 4. Galen's Architecture

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  Galen of Pergamum, born in 129 AD, turned Hippocratic humorism from a loose collection of ideas into a formal system. One of the reasons why the humoral theory became such a success, the source notes, is the sheer authority of Galen's writings. His commentary on On the Nature of Man became the starting point for the entire humoral tradition.

  Galen believed that humors were formed inside the body rather than ingested directly, but he held that different foods had the potential to push humor production in different directions. Warm foods tended to produce yellow bile. Cold foods tended to produce phlegm. Seasons, periods of life, geographic regions, and a person's occupation all shifted the balance. In his On the Doctrines of Hippocrates and Plato, Galen drew a direct correspondence between humors and the stages of life: a child corresponds to spring, a young man to summer, a mature man to autumn, and an old man to winter.

  Galen also incorporated the Platonic tripartite soul into his understanding of the body. He connected thumos (spiritedness), epithumos (desire), and Sophia (wisdom) to the three major organs recognized in his time: the brain, the heart, and the liver. Each organ had specific functions, called chreiai, and characteristic activities, called energeiai. He stated in On Hippocrates The Nature of Man that yellow bile in the soul causes sharpness and intelligence, the melancholic humor produces perseverance and consistency, and blood creates simplicity and naivety. He added, unusually, that phlegm has no effect on character at all.

  Galen identified eight temperaments in total. Four were defined by a single dominant quality: warm, cold, moist, or dry. Four others were defined by a dominant pair of qualities. It was this second group, named after the humors themselves, that history remembered: sanguine, choleric, melancholic, and phlegmatic.

• 5. Blood Drawn, Bodies Purged

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  Bloodletting was already a prominent medical procedure by the first century, but it took on even more significance once Galen declared blood to be the most prevalent humor. The volume of blood extracted ranged from a few drops to several litres over the course of several days, depending on the patient's condition and the doctor's practice.

  The logic behind every treatment followed directly from the theory. When a patient suffered from a surplus of one of the four humors, the goal was to expel the excess. This produced a medicine cabinet of elimination: purging, bloodletting, catharsis, and diuresis were all aimed at driving out whichever fluid was in surplus. Apocroustics were medications meant to stop the flow of malignant humors toward a diseased body part. Apophlegmatisms were medications chewed specifically to draw away excess phlegm.

  The Swiss physician Paracelsus, working in the sixteenth century, developed the idea that beneficial substances could be found in herbs, minerals, and alchemical combinations. Chamomile was used to decrease heat and lower excessive bile. Arsenic was used in a poultice bag to draw out the excess humors behind plague symptoms. These treatments, strange as they appear today, were not superstition to the people using them. They were applied science, derived from a model of the body that felt coherent and complete.

  Typical practices of the eighteenth century, such as bleeding a sick person or applying hot cups to the skin, were still being drawn directly from the same humoral logic of fluid imbalance.

• 6. The Body's Four Fluids Up Close

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  Swedish physician Robin Fåhræus, who devised the erythrocyte sedimentation rate in 1921, offered a striking retrospective explanation for how the four humors may have been identified in the first place. When blood is drawn into a glass container and left undisturbed for roughly an hour, four distinct layers become visible. A dark clot settles at the bottom, which Fåhræus identified as what the ancients called black bile. Above it sits a layer of red blood cells, corresponding to blood. A whitish layer of white blood cells appears next, corresponding to phlegm. The topmost layer is clear yellow serum, which maps to yellow bile.

  Black bile was generally seen as the most detrimental of the humors. Depression was attributed to excess or unnatural black bile secreted by the spleen. Cancer was also attributed to excess black bile concentrated in a specific area. The word melancholy itself comes directly from the Greek for black bile: melaina kholé.

  The French physiologist and Nobel laureate Charles Richet pushed back hard in 1910, asking rhetorically about phlegm, "this strange liquid, which is the cause of tumours, of chlorosis, of rheumatism, and cacochymia -- where is it? Who will ever see it? Who has ever seen it?" Richet called the classification of humors into four groups, of which two are absolutely imaginary, a fanciful exercise. By 1910 the evidence was overwhelming, yet the language had already embedded itself so deeply in everyday speech that sanguine, choleric, melancholic, and phlegmatic remain in use to describe personality types today.

• 7. From Baghdad to the Globe

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  Medieval Islamic medicine adopted humorism through Greco-Roman texts, and the Persian polymath Avicenna gave the tradition its most comprehensive medieval statement in The Canon of Medicine, published in 1025. Avicenna systematized the four humors and their corresponding temperaments, mapping each to specific symptoms, food types, and seasonal effects. The framework he built in that text became the foundation of medical education across the Islamic world and eventually re-entered Western Europe as classical learning was recovered.

  The Unani school of medicine, practiced in Perso-Arabic countries, India, and Pakistan, is based on Galenic and Avicennian medicine. It continues to use the four humors as a fundamental part of its methodological framework into the modern era.

  In the Byzantine Empire during the sixth and seventh centuries, Christian influences displaced some of the secular Greek medical culture, diminishing humoral medicine's reach. The revival of Greek humoralism did not begin until the early ninth century, driven in part by changing social and economic conditions. The theory's persistence across such different cultures and centuries reflects something more than inertia. Hippocratic medicine was highly individualistic: all patients were understood to have their own unique humoral composition, which made the system flexible enough to absorb local variations in practice.

• 8. Art, Drama, and Legacy

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  Seventeenth-century English playwright Ben Jonson wrote humor plays in which entire characters were built around a single dominant humoral complexion. The idea had already appeared in the character comedies of Menander and, later, Plautus, both of whom shaped their cast types around humoral surpluses. The humors were also a prominent iconographic theme in European visual art, appearing in paintings, tapestries, and sets of prints.

  In Shakespeare's The Taming of the Shrew, the character Petruchio uses humoral therapy techniques on Katherina. Both are described as choleric. Petruchio yells at the servants for bringing mutton, a choleric food, to two people already in a choleric state. He deprives Katherina of sleep and subjects her to a cold walk home, because cold temperatures were said to tame choleric temperaments. The play treats this as recognizable comic logic, not obscure doctrine.

  The theory of the four humors features in Rupert Thomson's 2005 novel Divided Kingdom. The connection between humoral imbalance and personality types was not formally tested because the list of temperament traits was not even defined until the end of the twentieth century. Modern medicine's use of the term "humoral immunity" to describe substances such as hormones and antibodies is not a descendant of the old humor theory. It is simply a literal use of the word humoral, meaning pertaining to bodily fluids. The practice of humorism in contemporary settings is classified as pseudoscience, but Avicenna's Canon of Medicine, written in 1025, remains one of the most thorough summaries the system ever received.