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Passions and Tempers
A History of the Humours
Prologue
In 1463, Giovanni de' Medici, son of Cosimo the Elder—the effective founder of the famed Medici dynasty—died in his native Florence, at age forty-two. What killed him was apparently a sudden onset of "phlegmatic complexion." Giovanni had been drinking too much cold water and had not taken enough exercise. Giovanni himself is not a key figure in history: it was under the rule of his famous nephew, Lorenzo "the Magnificent," that humanism and the arts flowered in Florence. Nor, for that matter, is his death of particular consequence. But a long, fascinating story underlies the diagnosis of the illness that killed him.
For centuries before Giovanni's birth, and for centuries after his death, the notion that an excess of water could induce an excess of phlegm was an accepted medical diagnosis. Phlegm was one of the so-called "humours," and the theory of humours was orthodoxy among doctors and patients alike. Humoural theory began in Greece in the fifth century BC with the body of work attributed to the physician Hippocrates. It then continued with Galen, the Roman doctor who adopted the Hippocratic doctrine in the second century AD. For over two thousand years thereafter, humoural theory explained most things about a person's character, psychology, medical history, tastes, appearance, and behavior. Doctors continued to work on the assumption that the body and the mind were intimately connected, that emotions were corporeal, that vapors caused headaches, and that a cold stomach caused indigestion. It was on the authority of humoural theory that they would advocate leechings,bleedings, cataplasms and fomentations as a cure for all ailments, from stomach aches to fevers, from skin rashes to chest pains.
The humours were substances that circulated within the human body, much like water in pipes. A humour is literally a fluid—humon in Greek, (h)umor in Latin—and bodily humours are fluids within a living organism. In the West, the theory developed that the human body was constituted of four of these humours, all central to its functioning. Phlegm was one them; the three others were yellow bile, black bile, and blood. They were concocted out of the heat of digestive processes in the stomach: food turned into so-called chyle in the liver, from where, thanks to the heat produced by these digestive concoctions, particles in the bloodstream called "vital spirits" were expedited to the heart, and from there to the brain. The cerebellum refined some of these spirits into smaller "animal spirits." Heat and cold, dryness and moistness affected the course of the spirits, and determined the effects of each humour on mood, thought, or health. There was thus a continuum between passions and cognition, physiology and psychology, individual and environment.
In turn, individual temperaments were the product of variations in the proportion of each humour in the body. An excess of choler (yellow bile) in the blood produced the choleric temperament; an excess of black bile produced the melancholic; an excess of phlegm, the phlegmatic; an excess of blood, the sanguine. Women tended to be moist, old people dry. Children's brains were moist, and this moistness explained their ability to learn and memorize. Regardless of one's predominant temperament, however, humours shifted according to what one ate and drank, to where one lived, and to climate and season. A sanguine person could suffer a bout of melancholy on one day, and a phlegmatic individual might become choleric on another. An excess of food or drink could cause a humoural imbalance, bringing about illness or, at worst, death.
Had Giovanni de' Medici lived today, no doctor in his right mind would have diagnosed "phlegmatic complexion," just as no serious physician today believes that a good bleeding will reduce a temperature. Once the connection between disease and the existence of germs had been firmly established, about 150 years ago, it was indeed impossible to hold on to the theory of humours. In fact, humours had already begun to lose theoretical credibility by the seventeenth century, when the circulation of the blood was properly understood. But in practice, the theory continued for another couple of centuries to sustain medicine and to offer a general scheme within which anatomy, physiology, and psychology could be made to fit. Some medical manuals were still recommending treatments based on humoural theory as recently as in the early 1900s. The principle underlying humours remained potent in the form of substances, particles, or currents traveling through the blood from limbs and organs to heart and brain, and back. It accounted for health and illness, for all sensation, emotion and cognition. The basic humoural model revealed how the sight of a beautiful maiden could trigger desire, induce a rush of blood in the veins, and increase the heartbeat, or how the excessive ingestion of wine resulted in a wobbly step and an altered mood.
Humours now remain familiar mostly metaphorically: we have all reacted cholerically to an insult, or awakened in a melancholy mood on a dark wintry morning. A mood is an humeur in French and an umore in Italian; and English-speakers still have to humor the whims of a temperamental colleague, face a Monday with ill-humor, and remain good-humored throughout the week. But humours do not survive just as linguistic habits: this book argues that their explanatory power has actually never gone away. It tells how and why this is, bringing them back to light, delving beneath the names we give to states of mind, to illnesses, and to the invisible world beneath our skin. It shows how humours have been recycled, continually reappearing in new guises, ever-present within evolving scientific systems and medical cultures. By now, the original four humours imagined by the ancients have been multiplied by the hundreds into hormones, enzymes, neurotransmitters, particles, and the like, constituting the hydraulic system that is our body, providing us with a partial picture of what is going on inside our organism.
We usually recognize a physical element in aspects of character or a particular mood: we say that mood swings might be related to hormonal shifts, or that an excitable person might be prone to high blood pressure. This is not very different from humoural thinking, which recognized the interdependence of mind and body. The historical equivalent of depression, for instance, is melancholy, which was understood to be caused by an excess of black bile in the organism; and the search for cures began long before modern antidepressants were conceived.
Natural remedies alone were available until the advent of pharmaceuticals, but herbal concoctions were the pharmaceuticals of yore. Today herbal concoctions and "alternative" medicines are increasingly popular. The mechanistic medicine which we have inherited from the Enlightenment, and according to which our bodies are mechanisms that must be taken apart in order to be understood, dissatisfies many of those who resort to such alternatives. A number of these alternative medical practices derive from Asian traditions, many of which are also humoural, based on the notion of fluids circulating within the body, energy flows, mind-body interaction, and balances between hot and cold, dry and moist. But few people know when, why, or how western medicine became so mechanistic; or that our attraction to Asian medicines might be due to their closeness to the humoural models that prevailed in the West until so recently. In effect, the history of humoural theory is not widely known. There is little awareness that there even is such a history to be told, and that its telling can reveal just how much our present is impregnated with the past.
Some of the remedies whose efficacy was once explained by humoural theory have survived its official demise simply because they have remained efficient. It still seems reasonable to eat root vegetables and "warming" spices like mustard, ginger, pepper, and cloves in the winter and "cooling" foods like green vegetables and lemons in the summer. There once was a humoural rationale to such practices: a winter chill supposedly strengthened the organism's own heat, thereby increasing appetite and the capacity for digestion, while one needed to counteract the heat and dryness of summer weather with cold and moist substances. Cures for mental or bodily ills based on these beliefs may or may not work. Humours no longer account for the cures that do work—not because they are entirely wrong, but because they are based on a largely mistaken picture of the body.
Mistakes, though, are interesting, and necessary for correct theories to exist at all. Today we understand the natural world and the human body in much greater detail than in the past; but there remains much that we do not know. This book concerns itself primarily with our capacity to make mistakes even when our questions are right: its premise is that all theories about how the world works are revealing, in the way that children's questions about the world are revealing. In a sense, we are all children in our relation to scientific information. Whether today, in fifteenth-century Florence, or in fifth-century-BC Greece, we need commonsense explanations, regardless of whether or not they are provable, or true. Even when wrong, a theory can help us understand, if not the world, then perhaps ourselves.
Popular beliefs have always interacted with learned theories about how our minds and bodies function. This history of humours is also a history of this interaction. The book chronicles the fate within the western world of the protean, invisible substances that are humours, from their origin in ancient Greece via the medieval, Renaissance, and modern worlds, up to the present day. It explores the sources of beliefs in the West about the relationship of body and mind, and about the role of humours in binding them together. It looks at the fears and myths that have surrounded these beliefs, at the gaps between medical theory and medical practice, between the visible body and its invisible processes, between clinical care and human pain. It presents a 2,500-year journey inside the scientific mind; but by its end, the distance traveled might reveal itself to have been remarkably short.
Passions and Tempers
A History of the Humours. Copyright © by Noga Arikha. Reprinted by permission of HarperCollins Publishers, Inc. All rights reserved. Available now wherever books are sold.
