Book Review

Passions and Tempers: A History of the Humours

N Engl J Med 2007; 357:2314-2315November 29, 2007

Article

Passions and Tempers: A History of the Humours
By Noga Arikha. 376 pp., illustrated. New York, Ecco, 2007. $27.95. ISBN: 978-0-06-073116-8

How a theory developed in Greece during the 5th century B.C. came to dominate medicine in Europe and the Muslim world for more than 2000 years is a fascinating story. Chandler Brooks explained in his 1962 book, Humors, Hormones, and Neurosecretions (Albany: State University of New York Press), how ancient notions of health as a balance of fluids — the original meaning of humors — prefigured modern ideas about hormones and endocrine balance. In contrast, Noga Arikha, in Passions and Tempers, emphasizes the humoralists' interest in the interdependence of body and mind and the persistence of that idea through the centuries all the way to Jerome Kagan's contemporary studies in psychology. Although a belief in the four cardinal humors — phlegm, blood, yellow bile, and black bile — has long disappeared from biomedicine, words like “temperament” and “melancholy” are still widely used, even if the word “humor” itself is now used primarily to describe a person's ability to tell or take a joke.

The main aspects of how the theory of the four humors evolved are well known. First described by Polybus of Cos, the theory was developed further by Galen (circa C.E. 129–216) on the basis of his own dissections and clinical experience. His rhetoric, learning, logic, and supreme self-confidence convinced many, and what was in his day a marginal theory came to dominate, abolishing all alternatives in the Greek world by C.E. 650.

This triumph came at a price, however. Galen's empiricism was replaced by the dogmatism of the classroom, and his hesitations and inconsistencies were removed as his successors strained to reduce his enormous output to manageable proportions. Eminent scholars in late antiquity and in the medieval Middle East — including Ibn Sina (Avicenna) and Maimonides — turned Galen's ideas into an all-embracing system of intellectual medicine. When academic learning revived in the West after 1050, it was this revised version of Galen's writing — now translated into Latin — that became the staple of the European universities.

The theory of the four humors was in many ways reasonable. It suggested correspondences with similar patterns of four — the seasons, the elements, the qualities, the quadrants of the heavens, and even the Gospels — and seemed to be confirmed by them. It allowed the physician to devise individual treatments for patients who were rich enough to pay for them, and since any of the numerous factors to be considered might suddenly change during treatment, the initial diagnoses were almost unfalsifiable. Only epidemic disease presented serious problems of explanation, but even in that area of medicine, humoral theories persisted until the 1880s.

Humoralism survived the new anatomy of the 16th century, the introduction by Paracelsus of chemical drugs, and William Harvey's discovery of blood circulation. Arikha rightly notes that Harvey believed that his discovery strengthened the case for humors. Alternative theories were produced aplenty after 1700, offering different (and usually short-lived) explanations for the phenomena that were emphasized by the humoralists. In the best chapter in the book, Arikha examines the ways in which humoral psychology continued to flourish — albeit in different guises. Arikha also describes how the rise of laboratory medicine in the 19th century pushed humoral medicine to the fringes, and it has survived mainly as a metaphor.

Other work done during the past decade, however, indicates that Arikha's book contains errors of fact and assumption. An emphasis on fluids or humors long predates Polybus in Greek medicine and may even be found among the Babylonians. The theory of the four humors did not become associated with Hippocrates until centuries after his death, and Galen had to contend with alternative interpretations by fellow Hippocratics as well as their opponents. Arikha's pages extolling Gondeshapur as Persia's cultural and academic capital and describing its crucial role in the transmission of humoral medicine to the Arab world wildly exaggerate the significance of this provincial backwater.

Moreover, humoralism is alive and flourishing in many parts of the Islamic world as Unani medicine (here wrongly conflated with Indian Ayurveda). It remains a remarkably flexible system. Some practitioners are happy to seek assistance from modern biomedicine and others, in contrast, put their faith entirely in a holistic approach to the body. By choosing to focus mainly on the role of humors in psychology, Arikha presents only one part of a rich and complex story. A proper history of the humors remains to be written.

Vivian Nutton, Ph.D.
University College London, London NW4 0BE, United Kingdom
v.nutton@ucl.ac.uk

Citing Articles (1)

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   Lynda S. Cook. (2010) Therapeutic Phlebotomy. Journal of Infusion Nursing 33:2, 81-88
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