Humoral pathology (jan 1, 460 BC – jan 1, 370 BC)

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Originally developed by Hippocrates and his followers, humoral theory sought to explain disease from a natural (versus supernatural) standpoint. The contemporary assertion that the world was made up of four elements—fire, air, water, and earth—played a profound role in the development of this theory with various bodily fluids coming to represent the four elements, respectively: yellow bile, blood, phlegm, and black bile. It was an imbalance of these so-called humors that caused disease. This informed medical treatments up until the 19th century and was demonstrated in the use of bloodletting to decrease the amount of blood in the body and reinstall the balance of the humors (George Washington died in 1799 after losing 5 pints of blood to bloodletting). The seasons also contributed to disease as they impacted the humors, explaining pneumonia in the winter and nosebleeds in the spring. Clearly, in the latter case, the body had too much blood and was trying to get rid of it via the nose, so naturally, a patient should be bled to encourage the humors back into balance. Historically, this logic led to an increase in bloodletting in the spring compared to other seasons. Many more factors, including lifestyle, diet, etc., might affect the determination of which humor was out of balance, and thus, what treatment was necessary to restore balance.

Humoral pathology impacted the thinking of many schools of medicine. Galen relied on the humors heavily and employed many herbal remedies among other treatments rebalance them. Objections to humoral theory began to arise with a better understanding of the body (Vesalius) and how death was effected by specific organs (Morgagni). The arrival of germ theory was the final nail that sealed the coffin.

May you be of good humor today.

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