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Michael Dirda
Balancing the four humours was the key to health in early Western medicine.

By Michael Dirda
Sunday, June 17, 2007

PASSIONS AND TEMPERS

A History of the Humours

By Noga Arikha

Ecco. 376 pp. $27.95

Some people say that the magic number is three, and some that it's seven, but there are other possibilities. For instance, Fagin, the con artist of Oliver Twist, pointed out that the only truly magical number was number one -- and his is clearly the preferred modern viewpoint. But the ancients made a case for the number four: The philosopher Empedocles argued, according to Noga Arikha, that "all matter was divided into four opposing pairs of principles (hot and cold, dry and moist) and four elements (air, earth, fire, water)." Moreover, there were four seasons, four points of the compass, and, not least, four humours.

The humours were, in Arikha's words, "substances that circulated within the human body, much like water in pipes. A humour is literally a fluid -- humon in Greek, (h)umour 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 of 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."

This theory of the humours has lain at the heart of Western medicine and psychology for well over 2,000 years. Not until the 17th century did science begin to construct a substantially more accurate picture of human anatomy: In this respect, William Harvey's 1628 monograph on the circulation of the blood may be likened in its impact to Copernicus's proof that the planets revolve around the sun. From then on, the theory that good health was determined by humoural balance gradually went into a decline.

Yet even now the humours leave a legacy in our linguistic habits. People can be in a good or bad humour. We speak of bilious and sanguine and phlegmatic temperaments. Melancholy, the most studied of our moods, derives its name from melaina (black) and chole (bile). In some ways, Arikha argues, the humoural view of the self is still very much with us, under new names and guises.

Hippocrates, to whom doctors still swear an oath, established the basic outline for a humoural definition of health. "Disease was understood as a state of imbalance or dyscrasia between the humours that made up the body's krasis, its general constitution or complexion. Curing a disease meant rectifying the imbalance within the organism by returning the humours to their proper 'mixing' or eukrasis, and thereby to a healthy state of balance, or isonomia."

How was this to be accomplished? Sometimes, a moderate diet, quiet, a little exercise might be enough. But often the physician would need to draw off whichever humour was in excess. This could take the form of, say, induced vomiting or of enemas, though the most celebrated method was to bleed a person, either by opening a blood vessel directly or by using cups or leeches. Opposites were also useful in restoring isonomia: A "cold" disease might be cured with a "hot" substance. Almost inevitably then, the ideal of humoural balance, of nothing in excess, shades into ethical theory. We must keep our passions in check, lest our tendency to anger, melancholy or lust result in an internal imbalance, one that might lead to serious physical impairment or some form of insanity.

Though the humoural theory of health and temperament provides the connecting thread of this history, Arikha's book is also, by its nature, an overview of Western medicine. She discusses the speculations of such figures as the semi-legendary Asklepios and the vastly influential Galen, traces the impact of Arabic medical study, examines the effectiveness of herbal "simples" and other folk medicines during the Middle Ages, treats seriously the Hermetic lore, alchemy and astrology of the Renaissance, and analyzes the theory of the passions during the 17th and 18th centuries. There are discussions of witchcraft, mesmerism, phrenology (that the shape of your head discloses your personality), blood transfusions, inoculation, the sympathetic nervous system, and the major medical advances of the 19th century. She ends with a discussion of psychoanalysis and the latest developments in pharmaceutical research. In short, Arikha offers a brief, if occasionally dense, account of how men and women have thought about their bodies and their souls.

She is at her best when discussing melancholy and love-sickness, "uterine fury" and satyriasis. For such are the possible consequences when erotic obsession upsets the proper functioning of the humours. According to the 17th-century antiquary Robert Burton, in a passage from The Anatomy of Melancholy that mirrors the erotic vertigo it describes, many lovers "are carried headlong like so many brute beasts; reason counsels one way, thy friends, fortunes, shame, disgrace, danger, and an ocean of cares that will certainly follow; yet this furious lust precipitates, counterpoiseth, weighs down on the other; though it be their utter undoing, perpetual infamy, loss, yet they will do it, and become at last insensati, void of sense; degenerate into dogs, hogs, asses, brutes; as Jupiter into a bull, Apuleius an ass, Lycaeon a wolf, Tereus a lapwing, Callisto a bear, Elpenor and Gryllus into swine by Circe."

By the Enlightenment, however, when scientists referred to the mind, they clearly meant the brain. "Nerves," says Arikha, "were the humours for an age of cerebral supremacy." By the time of Freud, the humours had again been reconfigured:

"Hysteria occurred when repressed anguish surfaced like a message in a bottle, or indeed like humours within a hydraulic organism. Freud posited the existence of an unconscious driven by the libidinal humour, the locus of repressed conflicts between the parts of a new tripartite soul -- the ego, the id, and the superego, vaguely corresponding to the old appetitive, sensitive, and rational souls. . . . The notion of an unconscious that we somatized in various, sometimes extreme ways was a return to humoural form. It was an acknowledgment that our organisms were traversed by stuff invisible to the conscious eye, that our innards were as present to our sleeping, dreaming, neurotic, or maddened selves as our skin was smooth. And it was a recognition that, however much we shoved the terror of our bloody origins beneath the garb of our conscious, thinking minds, the mystery of our primal, humoural embodiment returned, violently or surreptitiously."

Educated at the prestigious Warburg Institute and a specialist in the history of medicine, Arikha doesn't shrink from occasionally voicing her own views, especially about contemporary health care. Modern medicine, she says, "chops us into bits. It has become so specialized that Hippocratic doctors might not recognize today a profession whose goal was the care of illness through the understanding of the whole patient. Localized medicine can work wonders, of course. . . . But ever since we realized that our hearts were pumps and not the seats of vital souls, our medicine has become increasingly mechanistic, focused on soulless pulleys, easily forgetful of our complex humours."

For, as Arikha insists, our inner selves remain singularly elusive. "A map of the brain, or indeed of the humours, can only identify features of the landscape; the experience, meaning, and value remain for the emotional traveler to discover. . . . Chemistry cannot tell us all there is to know about what goes on in a depressed individual, or in any mind; nor can it account for the sense of self. The 'explanatory gap' between a scientific theory and actual experience remains identical through time, whether the scientific theory is based on humours or on hormones."

Passions and Tempers may excite passions and tempers in some of its readers, as a good work of intellectual history should. You will learn a lot from its pages. But one of its lessons most adults already know: However smart, creative or holy we may think ourselves, we are still fastened to the vexatious flesh, in all its glory and terrible fragility. ยท

Michael Dirda's e-mail address is mdirda@gmail.com

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