The Enduring Legacy of Humorism in Medicine: A Journey Through Millennia

For over two millennia, both Eastern and Western medical practitioners adhered to the idea that a harmonious equilibrium of four bodily humors, or "fluids," played a significant role in shaping our physical and mental health. The origins of this concept, known as the four humors, can be traced back to ancient Egypt and Mesopotamia. It was Hippocrates, during the fourth century BCE, who formalized and integrated these ideas into medical practice, giving rise to the system of humorism. According to this theory, good health depended on maintaining a balance among four essential fluids: blood, phlegm, black bile, and yellow bile. Any excess or deficiency of these humors was believed to lead to illness.

During ancient times, melancholy was thought to result from an excess of the "black bile" humor, and people believed that the planets had the power to restore the balance of these bodily humors. This particular stained glass artwork, created in the southern Netherlands around 1530, bears the title "The Planet Saturn Expelling a Monk with a Pig's Head, or Time Banishing Melancholy."

This revolutionary concept replaced the earlier prevailing belief that diseases were caused by malevolent supernatural spirits. Over time, humorism gained widespread acceptance and became the foundation of medical treatment in the Greco-Roman world, championed by figures like Galen. Galen further postulated that imbalances in the humors were responsible for distinct temperamental traits, categorizing individuals as sanguine (associated with blood), phlegmatic (related to phlegm), melancholic (tied to black bile), or choleric (linked to yellow bile). Humorism gradually spread across various regions, adapting to local influences, reaching as far as the Muslim world, China, India, and Western Europe. In "The Canon of Medicine" (1025), the renowned Muslim physician Avicenna expanded upon the connection between humor imbalances, changes in temperament, and the onset of diseases, proposing an association with the vital organs—the brain and heart.

During the Elizabethan era, efforts were made to maintain humor balance by making dietary adjustments, engaging in specific exercises, choosing appropriate clothing, and even modifying bathing practices. Interestingly, bathing was considered more detrimental to men than women during this period.

In Western Europe, a medical practice known as "heroic medicine" emerged. It aimed to restore humor balance through extreme measures such as purging, inducing vomiting, and bloodletting. Tragically, George Washington's death in 1799 is often attributed, at least in part, to the excessive bloodletting he endured, losing approximately half of his total blood volume. Less aggressive treatments involved applying heat, cold, moisture, or dryness to restore equilibrium. Humorism remained the dominant paradigm for understanding well-being and medical practice until the nineteenth century when modern medical theories, rooted in advances in cellular pathology and the discovery of biological and bacterial causes of disease, gained widespread acceptance.