In Our Time - The Four Humours

Episode Date: December 20, 2007

Melvyn Bragg and guests talk about blood, black bile, yellow bile and phlegm. These are the four humours, a theory of disease and health that is among the most influential ideas aver conceived. According to an 11th century Arabic book called the Almanac of Health, an old man went to the doctor complaining of a frigid complexion and stiffness in winter. The doctor, after examining his condition, prescribed a rooster. Being a hot and dry bird it was the perfect tonic for a cold and rheumatic old man. This is medicine by the four humours. The idea that the body is a concoction of these four essential juices is one of the oldest on record. From the Ancient Greeks to the 19th century it explained disease, psychology, habit and personality. When we describe people as being choleric, sanguine or melancholic we are still using the language of the humours today. It also explains why, in the long and convoluted history of medical practice, pigeon livers were an aphrodisiac, blood letting was a form of heroism (and best done in spring) and why you really could be frightened to death. The theory was dismantled from the 17th century but in its belief that the mind and body are intimately connected and that health requires equilibrium the humours retain an influence to this dayWith David Wootton, Anniversary Professor of History at the University of York; Vivian Nutton, Professor of the History of Medicine at University College London; Noga Arikha, Visiting Fellow at the Institut Jean-Nicod in Paris

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or wherever you get your pods. Thanks for downloading the In Our Time podcast. For more details about In Our Time and for our terms of use, please go to BBC.co.com.uk forward slash radio four. I hope you enjoy the program. Hello, according to an 11th century Arabic book called the Almanac of Health, an old man went to the doctor complaining of a frigid complexion and stiffness in winter. The doctor, after examining his condition, prescribed a rooster.

Being a hot and dry bird, it was the perfect tonic for a cold and rheumatic old. man. This is medicine by the four humors, which are black bile, yellow bile, blood and phlegm. The idea that the body is a concoction of these four essential juices is one of the oldest on record. From the ancient Greeks to the 19th century, it explained disease, psychology, habit, and personality. When we describe people as being choleric, sanguine, or melancholic, we're still using the language of the humus today. It also explains why, in the long and convoluted history of medical practice, pigeon livers were an aphrodisiac, blood-letting, was a form of heroism and why you really could be frightened to death.

With me to discuss the four humours at David Wooten, Professor of History at the University of York, Vivian Notton, Professor of the History of Medicine at University College London, and Noga-Arica, a visiting fellow at the Institute, Jean-Nico in Paris. David Wooten, the first record we have of the four humours is a book from the fifth century called The Nature of Man by the Greek Polybus. What, in Polybus opinion, were the four humours, and why did they work?

Well, you've just listed them, their blood, flam. yellow bale and black bale. And before that there had essentially been three humours. And he invents, is perhaps a strong word, but he introduces the fourth humour to line up the humours with the notion that there are four elements, earth, air, fire and water, and that there are four qualities hot and dry,

hot and cold, dry and wet. And so he's got the body in line with Empedocles' views about the universe, which come about 50 years before. And Pellibis is the son-in-law of Hippocrates, the great founder of medicine. and he's roughly contemporary with Plato. So that Plato in his later writings is taking up this way of thinking, and from that it passes into the long medical and philosophical tradition of Western culture.

What did you mean by humours, David, and how did they work? What are we talking about? Well, they're fluids. So you've got this problem of the notion of a dry fluid, something like a treacle, you might think. And they run all through the body so that they're all present in the blood. So if you tapped some blood from someone and put it in a cup, and let it sit for a while, it would separate out into these four humours.

And the humour of blood would be one of the four humours within the substance you removed from the veins. How far is this an abstract concept, which we know the Greeks developed to such a refined extent, and how far is this based on observation? It's a combination of the two. I mean, obviously, if you think about what comes out of the body, there's blood that comes out if you cut yourself, there's vomit, which has a lot. is thought of us having bile in it. There's phlegm that drips from your nose.

And so there's the notion that these humours are visible in the things that come off the body. And black bile is particularly visible in dark excrement. So they can be seen in daily practice. And the assumption is also that if you cut someone open, you will find them. So you'll find yellow bile in the gall. You'll find black bile in the spleen.

You'll find blood coagulated in the liver. And you'll find phlegm in the brain and in the lungs. So they have locations in the gall. body. What in this meaning practical terms? How did the Greek doctor go about understanding and treating diseases? Well, the assumption is that if you get the humors into balance, then you have a healthy person. And so health consists in having the correct balance of the humus. Disease is what occurs when the humors go out of balance. And then the question is, how do you bring them back into balance? And there are two ways of doing this. One is by feeding the right

food to someone, so you feed roosters to someone who's too frigid. And the other is by removing from them the excess of something. And so by letting off the blood, you can let off all four of the humours, but you can also make someone vomit, and that will pretend to get rid of the bile. You can give someone a purge and induce diarrhea, and that will tend to get rid of melancholy, of the black bile,

and so on. So that the three standard therapies become blood-letting, inducing vomiting, and inducing diarrhea. Can you just develop this idea of balance or equilibrium a little, because it's a fascinating one, isn't it? It's a center of the whole enterprise. It's the center of the whole enterprise, and it's

power, it leads to the assumption that one you can remove excess to bring things back into balance and the other is you can treat by opposites so you can introduce more of something in order to reintroduce the balance. And its power must come, I think, from the fact that the balance, which you weigh things with, the steel yard, is the earliest scientific tool. And it's incredibly sensitive. So small changes may have big effects on a balance. And that's presumably why the balance becomes the metaphor with which they understand the human body. Thank you. Vivian Nutton, the idea of four humours wasn't the only theory of an offer, as I understand it. Some argued there were five fluids, some said there were 12, but it was Galen, later on, five or six centuries after Polybus,

who plucked the four humours from then relative obscurity. Can you tell us what he made of them and why he was so significant? Well, Galen is significant because he turns what is a minority, theory into a theory that dominated Western and Eastern medicine for centuries to come. He himself doesn't choose the theory of the four humors. His teachers and their teachers before him had long believed that that theory of the four humors went back to Hippocrates. They didn't know much about polybus, but they thought the theory was that of Hippocrates, the great doctor in the fifth century. Galen takes up these notions from his teachers, and by a remarkable combination of individual effort, rhetoric, logic, and enormous learning,

manages to convince people that this is the only theory worth following. But you did say at the beginning of your remarked, this from relative obscurity, were the idea of the five fluids and the 12 fluids, were they in those six or seven centuries between Polybus and Galen, were they in the ascendance? There was a whole range of theories. concentrate on fluids, any number of fluids. Some people see things like violent phlegm as nasty things which are created out of blood, but many people have views of medicine of the human body as been based on atoms and pores, on a whole range of different things. And Galen in his time said,

of course there were people who don't believe in any theory whatsoever and just treat people. So we've got this man Gaelan who wrote, as I understand it, about 200 books, who lived to a great old age, who was an advertisement for his own medicine. And you did express awe yourself. Why were his views? Why did they become so extraordinary authoritative that they were unchallenged for centuries and centuries? It's, I think, because of his own personality. When he writes his books, he is always right.

he is incredibly accurate as a debater, as a logician. He sees the bad points of his opponent's views very quickly. He also has a remarkable sense as a doctor of observation. And finally, he was doing things that other people were not, such as carrying out anatomical experiments. And he was a successful doctor, who rose to be the Empress physician in second century AD. So all these together gave a new, I think a new impetus to Hippocratic Medicine, which is what he thought he was teaching.

And for reasons we don't entirely know, within a hundred years, his theory had become almost totally dominant. Did you establish an academy like Plato's Academy or Aristotle? No, as far as we know, he refers to friends, he refers to pupils, but his friends did happen to be the emperor's uncle and the Lord. leading politicians of the time. Did he bring any more evidence to bear about the thing that David Wood was talking about, the notion of the fluids, when you looked in there were the fluids and blood contained, and so on so forth, did he bring more evidence to back up his emphasis on the predominance of the four humans?

He experimented. He believed that one should carry out experiment, and he believed that his own experiments and his clinical practice showed that his vision, view was right and that balance was extremely important and that you could demonstrate that it was something to do with these four fluids. Noga Rica, how were the four numbers, the four humour, sorry, seen to connect with other matters like aging and astrology and how did this fit into the scheme of things? Well, the very idea, the humours, as David was saying before, has something to do, is a way

of defining the microcosm of the body in relation to the mass. macrocosm in the world. And humans, the human microcosm fits into and corresponds to this macrocosm in a very intimate way. So this idea that the human body is entirely part of nature. And so humors were considered just one aspect of nature. There were the most, in a sense, in a sense, one of the reasons for which the, uh, they became such established, uh, eventually, as Vivian was saying, it became such an established idea. And it was so, easy to transmit was that this idea that

each humor, for example flame corresponds to wintertime, it's cold, it's wet. That's an idea that eventually became more and more established. Same thing, blood is warm, humid, corresponds to springtime.

It also actually happens to be the most positive in the sense of the humors. You have melancholy, black bile, which is dry and cold, corresponds to autumn. But the humours that you have change as you go older, don't they? And they change as you go. They can change through the day.

So doctors are in a good position to prescribe and then they say, but that was this morning. You've changed about this evening or this was not a hot spring, therefore this did, and gave them great play inside this system, didn't it? Yes. It's a distance at once deterministic and also quite, it allows

for quite a lot of freedom. Because on the one hand, the human beings are born under a certain constellation. that corresponds, of course, to a season, and that corresponds, therefore, also to humoral complexion. And so that sense, we are born, each one of us is born with a certain temperament,

or complexion is actually more or less synonymous in this case. On the other hand, of course, yes, each time of day corresponds another humoral state. And women and men, for example, have different kinds of humoral complexions. Children's brains are supposed to also be warm and moist, which accounts for their inability to learn. It's the obverse for old age,

which also corresponds to evening. So in a sense, all these correspondences are almost, there's something very common sensical about this vision. And it fitted in very well with astrology, didn't it? It was a great dominating intellectual matter at the time. Absolutely. Though it is actually quite a matter of debate

at a wet extent and when and who exactly establishes correspondences between astrological constellations and humoral complexions. One thing that interested me reading about this would there seem to be very

no difference whatsoever in treating the body or the mind. They run into each other and they were the same thing which has been such a contentious thing over the last two or three hundred years but then for this over 2,000 years and so these humour

has affected the character and the personality can you just explain the character traits associated with one or two of the humors? Well, we still use, as we were saying at the very beginning, as you said in the introduction, we still use those adjectives, choleric, inflegmatic, melancholic, sanguine, and most of us still know what these adjectives mean.

We correspond to certain personality types. The humoral system is holistic for a whole range of reasons. There's actually a very complex theory of the mind that grew in a sense alongside or is internal to the development of sort of humoral theory, though they actually are separate. What was that? Well, that might be a subject for a different,

for a whole other program. But the psychology developed by Plato and by Aristotle of the seats of the soul has actually a resonance also with the conception, at least the way you conceive how humors work and how they travel from between all the key organs of the body. And the idea was that the three main organs of the body were liver, heart and brain. And so you have the humors first concocted out of child, so to speak, in the stomach, going into the liver,

traveling from the liver to the heart. So there's this idea that there was actually vascular connection between liver and heart, which took a very long time to be shown. Actually, this took a very long time to be shown to be completely fictitious, and then from the heart to the brain. and in each one of these organs is also the seat of a type of soul. So the liver is the heart as the seat of the appetitive soul. In a sense, you know, our basic desires, our basic needs

that we share also even with the vegetal kingdom. The heart is the seat of the sensitive soul, which is also about perception and so on, which we share with all other animals. And then the brain is the seat of the rational soul, which supposedly we, only humans seem to have it a very, developed fashion. And so the idea that you have these, then you have these animals, these spirits, vital and sensitive and animal spirits going from an organ to the next.

Would you like, and would either of you like to comment on this? Because this is, Vivian. Well, one of the things that Galen does is take Plato's psychology, which is the three parts, and try and argue that by his own anatomical experiments on animals, he can show that there are three separate systems in the body. And in his view, and this is perhaps one of his main contribution, he strongly insists on the interrelationship of mind and body, not just that if one drinks too much, one's mental facilities are likely to be a little less. Or sharpened in some cases.

Or sharpened. But the other way around. And that if you suffer from grief, for instance, that has quite a definite impact on your physical condition. And he's the founder of stress diseases. And of course, humus run through the animal kingdom as well as amongst human beings. So cats are melancholy. They keep to themselves.

They're cold. They're dry. Consequently, they're grey fur. The standard Elizabethan cat is a grey tabby. They think a lot. Hairs, which, according to common law, run where their eyes shut and sleep with their eyes open are obviously philosophical creatures and also suffer from melancholy. And so you

can go through the animal kingdom and identify any animal which is the predominant humour in that animal. And if you draw a picture of a cat in the 16th century, it always looks miserable because cats are melancholy. Can we stay with the complexity of it for a moment, David, which Noga took us into a little bit. The system I loved the complexity of it

because it just inhabited every part of thought, didn't it? It took in all that was being thought of at the time. And in the brain, astrology, actually curing somebody or trying to cure somebody. Sorry, I'm contradicting myself now because it had to be proved, hadn't it? They had to prove that it worked

so that people went along with them. They had the blood-letting work, for instance. How did they sort of hoodwing people for so long? In many ways, it's a self-confirming system. I mean, any medical therapy that you believe in tends to work. So if you treat people, you induce the place. placebo effect and people tend to get better. And so doctors through this whole period from polybusts through until the 19th century are making their patients feel better because they're paying attention

to them. And to some degree bloodletting does have, does make you feel better. It tends to lower your temperature. It tends to give you a good night's sleep. And so you feel better after having your bloodlet. The fact that it's probably done you in the long run more harm than good isn't something the patient's going to be aware of. The patient is going to feel that they've improved through the bloodletting. Yeah. Actually, it's very good if you have high blood pressure, but maybe not so good if you're

pregnant women. But the adiosid also did bloodlet pregnant women, which was maybe not such a good idea. And some people did die. But no, the point, I think one of the reasons for which it seemed to work, and I think it's also the rhetorical force of the

expert, the trust and expertise. A doctor has read many books. and that is, in instance, reason enough to trust in the doctor. There's an idea of high knowledge that is going to help you, help your lowly body in his sense. This established by Galen, as you emphasized Vivian Notton, went into the Christian medicine and then went into the Arabic world. In Baghdad, a man called Ibn Bhutlan wrote the tables of health,

and then we had Avicenna who elaborated the four humours very extensively and did his listings, this famous listings. Can you tell us when it transferred there, was it added to it, was still practice, so we're still pushing on with that thing and that thing sort of set in motion by Galen? One of the great advantage of the humoral scheme is it's so flexible and it can be added to and added to. And Galen himself is rather inconsistent.

He talks, he doesn't write, most of his books, are actually dictated. And when we talk, we make mistakes. His successors tried to eliminate all his contradictions and added to what he had said more and more and more of these correspondences, which in a sense amount to proof. The astrology comes in after Galen. And all his successes are doing, if you like, elaborating that system, trying to iron out the inconsistencies and produce something which is both perfectly obvious. We can see things changing and also provides the doctor with the ultimate get-out, which is that if something goes wrong, it's not necessary with the doctor's fault,

but of something that was beyond his control that suddenly turned out. So not only have you doctors saying, we can cure you and look at all the patients we have cured, but we also have them with very good explanations for why they fail. to cure you. I'm rather got ahead of myself there. Before he came to the Arab world, it was taken up by the Christians in Syria. And so it went through the various

religions of the Middle East, isn't it? One reason for which the system, especially Galen's version of all this, was so acceptable to the monotheistic peoples of Europe and the

Middle East, was that his thinking is teleological in the sense that he thinks in terms of final causes, in terms of the final purpose of a function. So, for example, instead of having eyes in order to see, you see because you have eyes. He has, it turns on its head this idea, the idea of our contemporary idea, of course, of evolution. I mean, it's this idea that really everything is there for a purpose. And so that, of course, makes a lot of of room for an idea of a God and for what we would call today intelligent design. We're, of course, always tempted to think in those terms. And Gillen was very, very good at tucking his thinking into that scheme.

Avicen, it seemed to me, took it up very emphatically, David Woodland. Did he give it more energy to power it on for another few centuries because of the way he elaborated it? Yes, and I mean... Because he was a hugely much... important influence in medicine, wasn't it? Yes, and there's this whole process of crystallising what Galen has said and formulating, as Vivian was saying, and formulated in clear and straightforward ways,

so that it becomes the standard teaching in the universities. And as universities are formed in the 13th century, it becomes part of the basic curriculum, which becomes uniform across Europe. And so it then pushes into the European universities in the early Middle Ages, and what are they doing with that theory then? Are they still experimenting? Well, experimenting is an interesting word here. I mean, I think it was clear from what Vivian is saying,

doctors go around saying, look at all the people we've cured. Of course, what they don't do is count the number of people who've died under their care. Counting only comes in in the 19th century and destroys this whole way of thinking. But what they certainly do do from the middle of the 15th century is begin to engage in careful anatomical dissection and begin to study the details of the construction of the body. this is the great work of Vesalius above all and what they did their show

is that Galen in lots of details is wrong Galen had by and large dissected apes rather than human beings but all that anatomical study doesn't disconfirm the theory about the fluids that are running through the body because what Vesalius is looking at is the hard structures in the body and his study of that

is compatible with retaining all the theory about the fluids that flow through those structures in the sense that the dissections, as you just said, start happening in the 14th century. Again, they had actually been forbidden, even undergaling, the dissections of humans, that is. And that, of course, does, as you just said, changes a lot. But it's also interesting to think of the fact that if you don't have a map

with which to read the body, the body won't tell you very much. And so even in the beginning, in the 14th century they were dissecting, finally looking at the brain, for example. It's very hard to look at a brain, really, because it does collapse quite quickly. But they were still reading into what they saw some of Gailin's own perceptions. For example, the idea of the Rete Emerabil, the miraculous network at the base of the brain

which the humans actually don't have. And that idea actually held on for another couple of centuries, as we said, until Vesalias. Can we talk about this document called The Lily of Medicine, which is an early medieval document? David, would you like to talk about that in housing? Vivian, you're passing it around the table. I wish for a fleeting moment to instantly dismiss.

it would have been nice to being on television. It went across the three-quarter line, like the old black to that one. Right, Vivian. Now for the touchdown. The Lily of Medicine was a university textbook, which was then translated as appears in various forms and systematizers, if you like, in Western Europe in the 14th century and later, the views, the humor.

views. It doesn't involve anatomy except very basic anatomy, but it provides you with the, if you like, the handbook for the doctor for what he should look for, how he should treat, and was very common. And so it penetrated from universities down into the local languages and help to spread the knowledge, if you like, down to people who are literate but not Latinate. we've actually slightly missed over the, I have, escaped the idea and avoid the idea of diet, which played a big part in this, didn't it, Noga? Very much so.

The key book that was a product, perhaps, of the Salonitian School of Medicine in the early Middle Ages, was the regimen sanitatisanitatum, which was a book that was translated into many languages, indeed, in all the vernacular languages, which was a handbook to how to lead your life in humoral terms.

necessarily in humoral terms. So, for example, when to eat, what to eat, when to have sex, when to have a phlebotomy, whether to have beer after a meal or not, whether to go for a walk and why you should in a certain time of day after a meal, how somebody who's fat should exercise, somebody who's thin should exercise, all this idea is very precise guidelines about how to lead your life in very practical terms. Let's take the diet briskly first. Does it make sense to us today, what they're saying then? Profoundly, this idea, again, I mean, the idea of balance, of course, makes complete sense.

It's a consensical idea. And so diet is one very potent form of medicine, given, of course, that what we eat has a direct effect on our organism and on the state of our humerus. So, for example, there are hundreds and thousands of examples, but most medicine, recipes actually are dietary recipes, are culinary recipes in this sense. They're telling the patient, well, for example, if you're all melancholy,

you should have nanophar, veal, avoid red meat, avoid lettuce, and so on. And of course, each doctor will have their own opinion in a way.

And in great detail, I mean, Burton's anatomy of malancholy contains long discussion of this. You should eat pike but not carp. You should eat partridge, but not duck and so on. Every bird, every creature, every vegetable has a different humoural effect on you.

Yes, you brought that up again, as you did earlier, which was very helpful, the pervasiveness of this inside of the culture, and it pervaded into literature. In England, he got Ben Johnson's every man in his humour, and in Julius Caesar, Brutus says, must I give way to your rash collar? So, just as an example, when Hamlet says to Rosencrantz and Guildenstern,

I have of late, but wherefore I know not, lost all my mirth, forgotten, all custom of exercises. How would the doctors of the time have diagnosed him, and what would they prescribe? Well, Hamlet, I think, tells us exactly what's wrong with him. Not taking exercise leads to melancholy. He says when the ghost appears to him that he's melancholic, and perhaps if you've got melancholy, that leads to madness, that leads to visions.

Perhaps he's suffering from insanity, and that's why he's seen ghosts. He also says that he's pigeon-livered and without gall. That's to say he's not got enough collar. That's why he can't take revenge. So Hamlet, we know, is suffering from melancholy, that's to say, from black bile, and he's got too little yellow bile, he's got too little collar. And the result of that is that he's become philosophical, he's become self-obsessed, he goes around talking to himself,

he reads too many books. And we know, therefore, exactly how he would walk. He would walk very slowly, looking down at the ground as he walked. He'd probably be carrying a book. We know that his hair would be lank and straight, because people with curly hair are choleric. This is getting very close to home for a lot of our listeners. We know that he'd have no beard on his chin and no hair on his chest.

So as soon as Hamlet walks on the stage, the audience would be able to tell by looking at him what his humour or complexion is, and then he would perform that humour for them. And so they would see him as a medical type in the same way that we might think of as someone who's manic-depressive. We might recognise them when they appear on the stage and say, oh, those are the symptoms of mania.

So when Elizabethan audience saw Hamlet, they would think at once that's a melancholic character and then everything he did would conform to that. Can I, excellent, can I now come back, Vivian, to how Gaelin is beginning to be displaced. Vassalis's anatomy discovers over 200 areas in Gaelan and there's this diagnosis of urine going on quite extensively.

What does that bring to the argument? Urin diagnosis is an interesting question because in Galen, you have relatively little about urine. But by 400 AD, his successors had brought together all his information on urine and were writing books on how to examine the urine. And urine is still a very important diagnostic aid. When you get to the 15th century, in 16th century, with the rediscovery of Galen's original works,

urine diagnosis by itself moves from being something of the great doctor, the university-trained doctor, to something which is practiced by the quack. And it's very interested in art to see that pictures of university doctors in the 15th century carry urine flasks. The end of the 16th century, it is the quack standing in the marketplace. and urine diagnosis quickly moves from being something which is highly learned to something which is the quack. So that's irrelevant in a sense. But is this all signaling that the great era of Galen is coming to an end, David Orton.

And you would have thought of come to 191628 when Harvey published his discovery of blood, the circulation of blood, but it doesn't seem to have done. It's a long lingering death. If indeed it's gone at all this theory. This is one of the great intellectual mysteries. Once Harvey has shown that the blood is circulating rapidly through the body, the traditional theory of the humans, which assumes that everything moves very slowly,

it ebbs and flows, that the body is a sort of great brewers vat, bubbling up all these substances, essentially cooking them. That's what concoction means. That should all disappear and be replaced by a mechanical idea of what's happening. And very much in theory in the late 17th century, you get understandings of the body as a mechanism, and Lemaitri in the 18th century is talking about the body as a machine.

And yet alongside that goes exactly the same medical therapies, phlebotomy or bloodletting, emetics, introducing vomiting and so on. And because the therapies survive, because medicine continues to be practiced very largely unchanged, the language preserves, and to some degree the assumption is still that these temperaments and humours are still present. And so there's a real disjunction between the understanding of physiology

and the understanding of character, temperament and therapy. But it's also true that Harvey, in fact, himself thought that his discovery had strengthened Galen's medicine by showing just how drugs can be transported around the body by blood. But the other point is that Galen disappears, if you like, from the medical universe in the end of the 16th century to be replaced by Hippocrates. And Hippocrates is seen by Galen and by the others. as the founder of the four humors. And so one can abolish Galenic medicine

whilst still retaining all those Hippocratic notions of balance. And you then concentrate on hypocritees. Naga, can we talk about Descartes, who is a contemporary of Harvey, and his bringing into play the notion that the mind and body were separate entities? How did this play with regard to the four humors? Well, Descartes actually was less of a duelist and the Cartesian's.

And even though he needed to insist on the dual, on the separation of mind and body for methodological purposes, in the end, the conjunction of both, the idea of the physiological mind re-entered his system, the idea that actually our mind is made of bodily substance in some level, more specifically, that our emotions are physiological and that the inform also our rational soul, that old idea of a more than our old holistic idea

actually did very much. He did actually hold on to it very much in his treatise on the passions, for example. When he wrote about the passions, he was actually writing in a very similar way to the way in which his predecessors had written On the other hand, he also did, it's true. The body that he described was a mechanistic body.

But a mechanistic body can also accommodate the idea, the hydraulic idea, the idea that you have humors circulating or moving around in some way or other in a hydraulic organism. And so in a sense, if you visualize the idea of an emotion going up to your brain and then triggering some event in your brain and you become aware of this emotion, That's a very basic and rather silly way of looking at how emotional consciousness works. But it's sort of worked as well. It sort of functioned as an idea. One of the interesting things about this stage, the 17th and 18th century,

is still you have intellectual almost dismantlement, practical with Vassalius, people challenging this idea, but still it goes on at the highest level. I mean, George Washington famously, heavy, It was treated by a doctor who called himself a heroic blood letter. And he'd sort that this heroic bloodletting hastened on the death of George Washington. So it's still being practiced. Heroic in this context is a technical term.

It means letting someone's blood until they lose consciousness. And so heroic bloodletting, as it were, takes them. You have to be brave doctor to do it because you have to take them close to the point of death. And there's a great, lots of disputes going on at the time about how much blood you should let. But traditional therapists believe that you should let out. considerable quantities. And Washington, in likelihood, dies as a consequence of that. Why has this, a point that I'd be, while I've been preparing for this, just kept intriguing me again. Why did this grip on study of medicine hold for so many

intelligent people in so many different parts of all for so long? And it sort of put, almost froze any development of this area of knowledge. Instead of growing up, as it were, he went laterally and brought in all sorts of other things, as you said, and enjoyed itself with partridges and pigeons and blunts and goodness knows what. Why was that? Well, I think my answer is that it is so powerful in the sense that it's invested in every aspect of people's lives. It's very hard to give up something that's invested in every aspect of your life that makes sense of everything you do, explains all your behavior, it tells you what to eat, tells you when to take exercise, explains to you your sexual

appetites and so on. It's very hard to abandon an idea that's as useful and powerful as that. I think there are two things that are required to step outside this humeral world. One is to move into a world of statistics where you start counting and seeing whether therapies actually have beneficial impacts or not by comparing different types of treatment. And that happens primarily from the 1820s on. And as soon as that happens, all these old therapies come into question. And the other is you need an alternative theory.

And the alternative theory that takes over eventually is the germ theory. And one of the interesting things is not only in 1628 you have Harvey on the circulation of the, blood. But you also, by then, have the microscope. And you can actually see germs, and you could actually, in principle, begin to study processes like putrefaction and see that putrefaction is a living process. But for anyone coming out of this Hippocratic Golanic tradition, putrefaction is a humeral process, and putrefaction is a result of an excess of a humour. And they have no notion that diseases are living organisms that inhabit the body. They assume that diseases are

malfunctions of the body from excessive humus. To move from the notion of the unbalanced body to the notion of the infection requires a whole mental revolution, which proves to be very difficult. There's also the point that in the middle of the 19th century, one stopped looking at the body as a whole, and one concentrated on looking at individual parts right down to cells. And that makes it very difficult to think in terms of that holistic galenism, that holistic, hypocratic view. And that was, I think, one of the reasons why, if you like, academic medicine from the 1830s, 40s, 50s, moved away from looking at the body as a whole to looking at individual bits and how they functioned. And once you're at that level, then humours become very, very problematic. There we go.

Yes, you want to come in. Yes, absolutely. No, the idea of infect, just to go back, one second, the idea of infection, there is a possibility of talking about the body isn't only producing, it's not only self-sufficiently enclosed, a humeral body, is also very much part of the environment, and one of the key hypocritic texts had been heirs, waters, places, and that's a text that in the sense, we still make sense today.

It's the idea that we are very much, and that our bodies are very much affected by the environment, by where we live, the latitude where we live, by the climate, and so on. And so you still have, that's another reason why the therapy is based on this awareness of where you live and how cold is the water where you live, for example, what air you are breathing, the idea of Biasma, why that idea survives. And I think there is, of course, a cut-off point between the holistic body and then the mechanistic body, as you were just saying, the body being cut off into little pieces.

But I think the continuum, I do think, continues between the body very much and within its environment, and then this idea that therapies have to be based, at least on that awareness. But if one looks at infection, there are some wonderful sociological studies done in the 60s and 70s in Darkest Finchley, which showed that, in fact, patients were found greater ease in accepting notions of germs, and bacteria. If they were married to notions of old humoral notions, I was out in the rain and it was cold and I didn't have

my hat on. Or I was in the sun and I got hot and that is why I developed tummy trouble. And so there's no, it's perfectly possible for, if you like, a humeral view to be combined with the infection view.

We talked about the way that it carried in the language of, let's call it Shakespeare's time, David. We are sadly running out of time now, because we are running out of time. It's very much in the language now, as NERGO pointed, it's still there. That's usually the indication of things are still active, isn't it? And do you think the idea of the four humours has not been banished beyond the microscope? Well, I think as Noga implied as a desire to return to a holistic therapy and a therapy that understands the complexity of human beings

and the relationship between mind and body. I think it's very easy to sentimentalize Hippocratic and Galenic medicine. Very often, you didn't go to a Galenic or a Hippocratic doctor. You sent a sample of urine to him, and he diagnosed you simply by looking at the color of your urine. We have 18th century doctors in Germany who specialize in treating women patients who regularly never met the women they treated. They treated them on the basis of letters brought by their servants. So the notion that this was a personalized medicine, I think, can be very much overstated.

It was often done by rote in the way that modern medicine is done by looking up the textbook and saying, well, you've got this condition and therefore this is the therapy. But I think there is a question in our society for a more personal, a more intimate, a more individualised medicine, and so people have a tendency to turn back to this as a form of that. And do you think there's any chance that they will turn back?

It will be useful again, Nanga? Not the idea of the four humors per se, but as David just said, there's the idea of again the holistic organism, the popularity of alternative therapies today just bears witness, certainly bears witness to this. People are more and more dissatisfied with the mechanization of the body and want to understand what are the relations between all these parts,

all these illnesses between body and mind. So that, together with the idea of balance, the popularity of spas and so on, speaks to very much what the humoral therapists at least were trying to get at. It's also true. It answers one important question. Why do I fall? ill.

The humus thing does. Yes. Is it my individual makeup that makes me susceptible? I'm going to leave it. I can't think of a better ending than that. Why do I fall ill? We can all ask that of ourselves. Thank you all very much.

Thank you, Nogarika. Thank you, David Witten, and Vivian Lutton. Next week, it's the Nicene Creed. The Testament of the Christian faith arrived out partly at the Council of Nicaa in 32580. Thank you very much for listening. We hope you've enjoyed this Radio 4 podcast. You can find hundreds of other programmes about history, science and philosophy at BBC.com.com.uk

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