Ever since I got rid of my gall bladder I've been thinking about the ancient medical doctrine of the Four Humors. A brief recap: until about 1830 or so, medical theory in Europe was based on the idea that the human body's processes are dominated by four "humors," and that illness is the result of an excess or deficiency in one of them. Each humor, in turn, is a combination of two of the four fundamental principles: hot, dry, moist, and cold.
So blood is a hot, moist humor. "Yellow bile" or choler is hot and dry (even though it's a liquid). "Black bile" (which doesn't actually exist, but is necessary for the theory) or melancholia is cold and dry. And phlegm is cold and moist.
We tend to scoff at pre-modern medicine, often with good reason, but it's actually kind of interesting to see that the humoral theory had a pretty decent track record.
Consider "Yellow bile" or choler. It's actually kind of a catch-all term for stomach acid, bile, and other digestive enzymes. A patient with an excess of yellow bile would be experiencing sharp or burning sensations in the upper abdomen — symptoms which could mean gallstones, ulcers, acid reflux, or (most likely) nausea caused by eating food which has gone bad. We still call that feeling "bilious." People with chronic digestive upset are inclined to be cranky, which is to say, choleric or bilious in temperament.
How do you treat an excess of choleric humors? Since bile is hot and dry, you have the patient consume cool, moist foods: vegetables, salads, cold water, maybe fish. That's actually about what my doctors made me eat after diagnosing my gallstones. It's a low-fat diet which probably would ease the symptoms of most gastric ailments. So, score one for humors.
"Black bile," also known as melancholia, is a little more tricky. It referred to what are now known as "bile pigments" in the feces, which are basically yellow bile after its has done its job in the digestive tract. In practice, an excess of melancholic humors referred to problems of the lower abdomen, in particular to constipation. If you know anything about the history of medicine, you know that much of it can be summed up neatly in one word: "laxatives." If you have a patient suffering from an excess of cold, dry humors, what do you give him? You give him hot, moist things: pepper, red wine, maybe some good hot soup. And, in general, those are not bad for constipation — especially after 1500 when the doctor could give the patient some good hot chili peppers to clean him out from stem to stern. Another hit for humors.
Aside: I'm not sure why melancholia and bowel complaints was associated with the sad, introverted personality traits of "melancholy." Certainly chronic constipation would make one somewhat unhappy, and I guess spending a lot of time on the pot could encourage introversion. Still seems like a stretch, though.
Phlegm means mucus in general, and refers mostly to respiratory ailments. You cough, you sneeze, and mucus comes out. Obviously your body has too much cold, moist humors. How to treat that? Keep the patient warm and dry, and give hot, dry things like onions and spices. As far as treatments for a cold (or anything else), keeping the patient warm and dry is always good advice. So I call that another victory for the humoral theory.
And now we come to . . . blood. An excess of hot, moist humors was the usual diagnosis for times when the patient was feverish, or had swelling (edema). Now, you could treat that by giving cool, dry things — except that there aren't many foods which fit the bill. Mint, maybe? Unfortunately, the other obvious treatment for a surfeit of sanguine humors was the direct approach: bleeding. Doctors loved bleeding patients. When someone was feverish or suffering from an infection they'd have a surgeon draw off a pint, sometimes more (they took three and a half liters out of George Washington during his final illness). It need not be said that bleeding is just about the last thing you want to do to someone who is fighting off an infection (especially if the surgeon isn't very picky about cleaning his lancet). Unsurprisingly, bleeding is the feature of humoral medicine we remember with derision today. Definitely a fail.
Now, I'm glad to be living in the era of science-based medicine. But it's foolish to dismiss the ideas of some of Europe's best minds over more than ten centuries simply because we have better tools than they did. The humoral theory was (kinda, sorta) scientific. It was based on observation and had some supporting evidence — especially since medical diagnosis with nothing but the doctor's five senses had a very high "noise to signal" ratio. And above all, sometimes it worked.
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