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12 November 2017

Scientific medicine is miraculous, but doctors still need a sense of the humours

While humoral medicine lacked truly effective treatments, it did possess a certain wisdom.

By Phil Whitaker

Our culture today still bears the imprint of a long-passed system of medicine. From the time of Hippocrates in Ancient Greece through to the dawn of scientific medicine in the 19th century, human temperament was understood in terms of four humours that were thought to exist within the body – blood, phlegm, yellow bile and black bile.

Imbalances between these humours were thought to be responsible for different moods and character traits – sanguine, phlegmatic, choleric and melancholic are all terms still in use today. Good health was felt to reflect a state in which the four humours were in balance; diseases arose when they were not.

Each humour was ascribed qualities blended from four natural states – hot, cold, dry and wet. Blood, for example, was hot and wet; phlegm, wet and cold. Depending on which humour was thought to be in surfeit or deficit, doctors would recommend changes in diet, environment and lifestyle directed towards restoring balance. Physicians’ enthusiasm for therapeutic procedures such as blood-letting and purging also arose from the same concerns.

Some of the concepts are remarkably enduring. Despite knowing about viruses, we still talk of having caught a “cold”. Draughts, or being rain-soaked in a chill wind, are frequently blamed, and we believe that wrapping up and staying warm is essential for recovery – to say nothing of the restorative powers of hot chicken soup. And the idea that you should starve a fever and feed a cold has continued currency.

Some of the practices of humoral medicine were highly damaging. Draining someone of blood is rarely a good idea (although, interestingly, we still bleed patients with diseases that involve iron overload or excess red blood cell production). Other ideas, while misguided, were more benign. Different foodstuffs were ascribed hot, cold, dry and wet properties, and would be advised as remedies for various conditions, either ingested or applied as poultices. Many new mothers today suffering from mastitis will still be told to place a cabbage leaf on the inflamed breast.

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While humoral medicine lacked truly effective treatments, it did possess a wisdom that became drowned out by the advances of the scientific era. Exercise regimes were a frequent component of a humoral doctor’s prescription. Today we are re-emphasising the value of physical activity in a wide range of conditions, from depression and stress through to heart disease and type 2 diabetes. A change of environment and partaking of “fresh air” were frequently prescribed, something modern-day researchers into the health effects of pollution, or the sense of well-being that connection with nature can bring, would readily recognise. And as for diet, the need for balance and moderation is an ongoing concern.

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Relaxation and sleep would have been key considerations for a humoral physician. The award of the Nobel Prize in Medicine this year to three American scientists for uncovering the workings of our internal body clock has thrown new light on how modern lifestyles clash with biology. Fully 50 per cent of us now routinely get less than six hours sleep – blunting our cognitive abilities, impairing our immunity and playing havoc with our metabolism.

If someone is in poor health then there are likely to be myriad contributors. Some, like genes or age, we can do little about. But what we eat, how much rest and recreation we grant ourselves, what exercise we take, our sense of security and autonomy, and our levels of deprivation, are all important determinants that can be addressed – some at a personal level, others socio-politically.

The success of scientific medicine has led to the belief that there’s a pill for every ill. Our medical forebears would be astounded by the efficacy of our drugs, but equally bemused by our inability to take care of ourselves. 

This article appears in the 08 Nov 2017 issue of the New Statesman, The Tory sinking ship