History of Alchemy 22 Interlude: The Medicine of Galen

The four-element theory combined with transmutation from Aristotle was adopted wholesale into medicine by the Greek doctor living in Rome, Galen of Pergamon (129 - 216 A.D.), in the form of "humors."

Humors are fluids of the body: blood, phlegm, urine ("yellow bile"), and feces ("black bile"). And like the four-element theory of Plato and Aristotle, the perfect balance of the humors was a special place to be: perfect health. Medicine did not take it as far as the alchemists, to the point of extended longevity, but the physician's role was to see where the humor lie, and remove excess humors to bring the body closer to balance.

Humorism

Humors were proposed back before 450 B.C. by Alcmaeon of Croton. We don't have any of his writings, but he is referenced by many, including Plato. he is said to have proposed that sleep is a consequence of the blood withdrawing from the skin into veins deep in the body. He also seems to have proposed many more than four humors, including amniotic fluid, the humors of the eye, and the humor of the ears. Evidence is sparce that he believed plants also had humors.

Galen pares down the many humors of Alcmaeon to four, probably under the influence of Aristotle. What of the fifth element of Aristotle, aether? That was a celestial element, and was perhaps the chief constituent of the soul of man (and animals and plants and rocks, etc.).

Physician practice in humorism involves detecting the balance of the humors. Looking at the skin and eyes reveals the state of blood, examining the nose and mouth reveals the state of phlegm, and of course looking at the patients "water" and feces was an essential part of the job. We have a few examples in film where this was done: The Madness of King George (1994) and The Last Emperor (1987) both have scenes of physicians doing this.

Many Greek texts were written during the golden age of the theory of the four humors in Greek medicine after Galen. One of those texts was an anonymous treatise called On the Constitution of the Universe and of Man, published in the mid-19th century by J.L. Ideler. In this text the author establishes the relationship between elements of the universe (air, water, earth, fire) and elements of the man (blood, yellow bile, black bile, phlegm). He said that:

  • The people who have red blood are friendly, they joke and laugh around about their bodies and for their appearance they are rose tinted, slightly red, and have pretty skin.
  • The people who have yellow bile are bitter, short tempered, daring. They appear greenish and have yellow skin.
  • The people who are composed of black bile are lazy, fearful, and sickly. They have black hair and black eyes.
  • Those who have phlegm are low spirited, forgetful, and have white hair.

Blood

The blood was believed to be produced exclusively by the liver. It was associated with a sanguine nature (enthusiastic, active, and social).

Yellow bile

Yellow bile was associated with a choleric nature (ambitious, decisive, aggressive and short-tempered).

Black bile

Black bile was associated with a melancholy nature, the word "melancholy" itself deriving from the Greek for "black bile", μέλαινα χολή (melaina kholé). Depression was attributed to excess or unnatural black bile secreted by the spleen. Cancer was also attributed to an excess of black bile concentrated in a specific area.

Phlegm

Phlegm was associated with a phlegmatic nature, thought to be associated with reserved behavior. The phlegm of humorism is far from phlegm as it is defined today. The French physiologist and Nobel laureate Charles Richet, when describing humorism's "phlegm or pituitary secretion" in 1910, asked rhetorically, "this strange liquid, which is the cause of tumours, of chlorosis, of rheumatism, and cacochymia — where is it? Who will ever see it? Who has ever seen it? What can we say of this fanciful classification of humors into four groups, of which two are absolutely imaginary?"

Empedocles's theory suggested that there are four elements: earth, fire, water, and air; with the earth producing the natural systems. Since this theory was influential for centuries, later scholars paired qualities associated with each humor as described by Hippocrates/Galen with seasons and "basic elements" as described by Empedocles.[24]

The following table shows the four humors with their corresponding elements, seasons, sites of formation, and resulting temperaments:[25]

Humor Season Ages Element Organ Qualities Temperament
Blood spring infancy air liver warm and moist sanguine
Yellow bile summer youth fire gallbladder warm and dry choleric
Black bile autumn adulthood earth spleen cold and dry melancholic
Phlegm winter old age water brain/lungs cold and moist phlegmatic

Influenc

Empedocles's theory suggested that there are four elements: earth, fire, water, and air; with the earth producing the natural systems. Since this theory was influential for centuries, later scholars paired qualities associated with each humor as described by Hippocrates/Galen with seasons and "basic elements" as described by Empedocles.

The following table shows the four humors with their corresponding elements, seasons, sites of formation, and resulting temperaments:

Humor Season Ages Element Organ Qualities Temperament
Blood spring infancy air liver warm and moist sanguine
Yellow bile summer youth fire gallbladder warm and dry choleric
Black bile autumn adulthood earth spleen cold and dry melancholic
Phlegm winter old age water brain/lungs cold and moist phlegmatic

 

Wikepedia: Humorism

Galenistic theory of medicine will last until modern medicine supplants it starting with William Harvey in the 1630's. Bloodletting will persist into the 1800's.

Bloodletting is an interesting example of how Galenistic medicine lasted so long. Draining blood, especially a significant amount, causes an adrenaline response. Adrenaline can cover a multitude of physical ailments, as I can attest by personal experience. When I teach, I'm very excited and full of natural adrenaline. If I'm sick, all symptoms disappear while I lecture, to return after I'm back in my office. Same for a hurt foot or something.

What the physician sees is that after a bloodletting, the patient's symptoms instantly heal. But after a time, when the physician has gone, the patient has a tremendous downturn and dies. The physician thinks he healed, and can blame any demise on the patient.

One wonders how many patients were killed by their Galenistic physicians.