The Register-Herald, Beckley, West Virginia

November 15, 2013

Humors theory: The correct balance of body’s four fluids

POINT BLANK: By John Blankenship
Register-Herald Reporter

— Recently, while reviewing Jane Austin’s novel “Sense and Sensibility,” I read about an early 19th century English doctor who treated his feverish patient, Marianne, by making an incision in her arm and draining some of her blood.

I knew that the practice was called bloodletting, but what would motivate any doctor to take from his patient a resource she actually needed to get well?

The cause, I learned, was the humors theory — a theory that strongly affected medical practice from ancient Greek times to the 19th century.

First, what was the humors theory? Doctors thought that the body held four liquids, or “humors,” namely blood, phlegm, black bile and yellow bile.

The unique balance or mix of these four fluids created a person’s temperament and affected his or her appearance.

For example, doctors thought that the domination of blood made someone sanguine — fat and jolly, pleasure-seeking and sociable. The domination of phlegm made a person phlegmatic — lazy or sleepy, relaxed or quiet. A lot of black bile created a cold fish, a melancholy person — pensive and solitary, analytical and thoughtful. Finally, a lot of yellow bile made a person choleric — ambitious and leader-like, and quick to get angry.

People became ill when their normal combination of humors was upset in some way.

The humors theory strongly affected how doctors diagnosed illness. When someone got sick, doctors tried to figure out why the patient’s humors were out of whack, and to what degree.

To help them decide, doctors used three diagnostic tools: pulse reading, urine analysis and astrology.

Doctors read the pulse to check out the heart and blood. In fact, they came up with a complex classification scheme to measure pulse duration, regularity and breadth for the specific type being examined.

Examining urine, too, was a way of checking how the humors were working. Urine was checked for color, consistency, odor and clarity. Doctors were trained to detect as many as 18 colors in this precious liquid. The instrument used, the urine glass, was divided into four even parts, each standing for a part of the body.

For example, if the urine at the top was cloudy, then the patient had head trouble. Because the doctor believed that the heavens influenced the human body, he had to connect the unbalanced humors to planetary influences.

Humors theory also affected how doctors treated illness. Having figured out why and how far the humors were out of balance, the doctor would try to restore order using a variety of treatments — some surprisingly helpful, and others outright quackery.

Some helpful prescriptions included changes in diet or daily activities, as well as medicines (age-old remedies tested by experience).

But the doctor’s faith in the humors also caused foolish practices, like bloodletting, or phlebotomy (bloodletting as a therapeutic measure), to restore the balance of the humors.

Since doctors believed that the four humors were linked by tubes, bloodletting would release excess bodily fluids.

As a medieval medical guidebook put it, “Bleeding soothes rage, brings joy unto the sad, and saves all lovesick swains from going mad.”

Bloodletting was a tune-up when the humors were out of sync, a procedure often done in spring and fall (with the help of astrology) to “attune the humors to new climactic conditions.”

Such medical practices may sound bizarre to us. The humors theory (the cause) surely led to strange diagnoses and treatments (the effects). But this practice made good sense to doctors in the past.

And when today’s doctor prescribes an antibiotic to fight infection, he is trying to put the patient’s body back in balance.

While the explanation may be new, this art of balancing has been practiced since Hippocrates’ day (460-370 BC).

Later discoveries in biochemistry, however, have led modern medicine science to reject the theory of the four temperaments, although some personality-type systems of varying scientific acceptance continue to use four or more categories of a similar nature.

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— Blankenship is a reporter for The Register-Herald.