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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.

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.

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.

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 first appeared in the 09 November 2017 issue of the New Statesman, The Tory sinking ship

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Why Jeremy Corbyn’s evolution on Brexit matters for the Scottish Labour party

Scottish Labour leader Richard Leonard, an ideological ally of Corbyn, backs staying in the customs union. 

Evolution. A long, slow, almost imperceptible process driven by brutal competition in a desperate attempt to adapt to survive. An accurate description then by Shadow Chancellor John McDonnell, of Labour’s shifting, chimera of a Brexit policy. After an away day that didn’t decamp very far at all, there seems to have been a mutation in Labour’s policy on customs union. Even McDonnell, a long-term Eurosceptic, indicated that Labour may support Tory amendments when the report stages of the customs and trade bills are finally timetabled by the government (currently delayed) to remain in either “The” or “A” customs union.

This is a victory of sorts for Europhiles in the Shadow Cabinet like Emily Thornberry and Keir Starmer. But it is particularly a victory for Scottish Labour leader Richard Leonard. A strong ally of Jeremy Corbyn who comes from the same Bennite tradition, Leonard broke cover last month to call for exactly such a change to policy on customs union.

Scotland has a swathe of marginal Labour-SNP seats. Its voters opted voted by a majority in every constituency to Remain. While the Scottish National Party has a tendency to trumpet this as evidence of exceptionalism – Scotland as a kind-of Rivendell to England’s xenophobic Mordor – it’s clear that a more Eurocentric, liberal hegemony dominates Scottish politics. Scotland’s population is also declining and it has greater need of inward labour through migration than England. It is for these reasons that the SNP has mounted a fierce assault on Labour’s ephemeral EU position.

At first glance, the need for Labour to shift its Brexit position is not as obvious as Remainers might have it. As the Liberal Democrat experience in last year’s general election demonstrates, if you want to choose opposing Brexit as your hill to die on… then die you well may. This was to some extent replicated in the recent Scottish Labour Leadership race. Anas Sarwar, the centrist challenger, lost after making Brexit an explicit dividing line between himself and the eventual winner, Leonard. The hope that a juggernaut of Remainer fury might coalesce as nationalist resentment did in 2015 turned out to be a dud. This is likely because for many Remainers, Europe is not as high on their list of concerns as other matters like the NHS crisis. They may, however, care about it however when the question is forced upon them.

And it very well might be forced. One day later this year, the shape of a deal on phase two of the negotiations will emerge and Parliament will have to vote, once and for all, to accept or reject a deal. This is both a test and an incredible political opportunity. Leonard, a Scottish Labour old-timer, believes a deal will be rejected and lead to a general election.

If Labour is to win such an election resulting from a parliamentary rejection of the Brexit deal, it will need many of those marginal seats in Scotland. The SNP is preparing by trying to box Labour in. Last month its Westminster representatives laid a trap. They invited Corbyn to take part in anti-Brexit talks of opposition parties he had no choice but to reject. In Holyrood, Nicola Sturgeon has been ripping into the same flank that Sarwar opened against Richard Leonard in the leadership contest, branding Labour’s Brexit position “feeble”. At the same time the Scottish government revealed a devastating impact assessment to accompany the negative forecasts leaked from the UK government. If Labour is leading a case against a “bad deal”,  it cannot afford to be seen to be SNP-lite.

The issue will likely come to a head at the Scottish Labour Conference early next month, since local constituency parties have already sent a number of pro-EU and single market motions to be debated there. They could be seen as a possible challenge to the leadership’s opposition to the single market or a second referendum. That is, If these motions make it to debate, unlike at national Labour Conference in 2017, where there seemed to be an organised attempt to prevent division.

When Leonard became leader, he stressed co-operation with the Westminster leadership. Still, unlike the dark “Branch Office” days of the recent past, Scottish Labour seems to be wielding some influence in the wider party again. And Scottish Labour figures will find allies down south. In January, Thornberry used a Fabian Society speech in Edinburgh, that Enlightenment city, to call for a dose of Scottish internationalism in foreign policy. With a twinkle in her eye, she fielded question after question about Brexit. “Ah…Brexit,” she joked. “I knew we’d get there eventually”. Such was Thornberry’s enthusiasm that she made the revealing aside that: “If I was not in the Leadership, then I’d probably be campaigning to remain in the European Union.”