An Image of the Times. Nils-Johan Jorgensen
(636–546), the astronomer and mathematician from Milet, introduced Water as the first principle and original substance. Anaximander suggested Air, Heraclitus Fire and Empedocles, the physician and philosopher, added Earth but accepted all four as equals.
Heraclitus recognized the eternal change of fire into different and separate forms, ‘the transformations of Fire are, first, sea; of sea half is earth and half fiery storm-cloud’. He reasoned that everything in the world is subject to perpetual change and decay caused by inevitable clash of opposites. He unwrapped the two basic ideas of the historian’s trade, change over time and causation.72 His favourite aphorism was, ‘you cannot step into the same river twice’. He also studied human nature, dreams and emotions. ‘I went in search of myself … you will not find out the limits of the soul by travelling, even if you travel over every pole.’73 The word ‘psychology’ springs to mind.
Hippocrates (460–357) separated medicine from religion and magic.74 The four elements continued in a new medical system as the four humours in the body. The humours were conceived in exact analogy with the cosmic elements and a perfect harmony in body and soul depended on a balanced and evenly proportioned distribution. The balance of health could be disturbed by a deficiency or excess of elements and by isolation of one element from the rest of the group. The constituents would vary with the four seasons, ‘as the year goes round they become now greater and less, each in turn and according to its nature’.75 Phlegm contained the primary quality of Cold in analogy with its parental element Water and was associated with the coldest time of the year. In the same way Blood and the Sanguine humour would increase during the spring because its corresponding element Air contained the qualities of Moisture and Heat which were the qualities of the seasonable weather. With the hot weather in the summer, yellow bile or Choler developed its natural disposition to Heat, the primary quality of the corresponding element Fire: ‘And in summer blood is still strong, and (yellow) bile rises in the body and extends until autumn.’76 Finally, the dry weather in the autumn exhausted the quality of Moisture contained in the blood and black bile or Melancholy would then dominate the constitution of man. Black bile gained its distinction of dryness from the primary quality of the corresponding element Earth. ‘In autumn blood becomes least in man, for autumn is dry and begins from this point to chill him. It is black bile which in autumn is the greatest and strongest.’77
The humoral theory, introduced and explored by the Hippocratic medical school, became the central aspect of medicine for more than two thousand years. The theory spread within the Hellenistic world and continued in Roman, Byzantine, Arabic and Chinese medicine. It finally obtained a new wave of popularity in European medicine with the Renaissance rediscoveries of ancient medical sources. The theory was not always accepted without discussion and opposition among the ancients. The Greek physician, Erasistratus, whose medical skill became known in Alexandria in the middle of the third century B.C., is the first on record to refute the humoral theory completely. The very prominent Greek medical scholar, Asclepiades, who introduced Greek medicine to the Romans at the beginning of the first century B.C., was also hostile to the doctrine.
The second century (A.D.) scientist and logician, Claudius Galenus deserves the credit for preserving the theory of humours.78 His explanations became the accepted authority for successive students of medicine until William Harvey’s circulation theory. Galen’s findings were introduced into Arabian medicine and made the basis for further elaborations in the eleventh century. These extensions were translated back into Latin from Arabic. Thus the medieval European humoral tradition was linked to Galenic (and Hippocratic) theories often sifted through an Arabian temperament and scholarship. Galen’s own interpretations and explanations of the humoral theory started from a recognition of ancestry:
Of all those known to us who have been both physicians and philosophers Hippocrates was the first who took in hand to demonstrate that there are, in all, four mutually interacting qualities … Hippocrates was also the first to recognize that all these qualities undergo an intimate mingling with one another.79
According to Galen moderate heat would produce blood and a sanguine complexion. Excessive heat developed yellow bile and a choleric complexion. Phlegm occured in the lungs when the quality of heat was weak and accordingly produced a phlegmatic complexion. Black bile in the spleen would abound in the autumn and promote a melancholic complexion. Galen used dissections regularly in his research. He quoted Aristotle and Plato and members of the Hippocratic school, Diocles, Philistion and Praxagoras, among authorities on humours. He points out that Praxagoras listed as many as eleven humours, but explains that this was only a refining and elaboration of the Hippocratic quartet. This kind of minutiae of the humoral theory is just a forewarning of the many Renaissance deviations into elemental obscurity.80 In ‘The Prologue’ to The Canterbury Tales a doctor appears and links medicine to astronomy: ‘The cause of every malady you’d got he knew, and whether dry, cold, moist or hot; he knew their seat, their humour and condition.’ With the discoveries of the original Galenic manuscripts in the mid-fifteenth century first-hand material became the point of departure for investigation and research in the field of humoral medicine. Galen’s genius and judgment was praised by Erasmus and mentioned by Rabelais and studied intently by Harvey as a prelude to his discovery.
Thomas Linacre’s translation of Galen into Latin, in particular De Temperamentis (1517) and De Naturalibus Facultatibus (1523), introduced the humoral theory to a larger reading public in England.81 Linacre sums up the diverse field of learning which helped to shape the intellectual climate of the English Renaissance. He was a Greek scholar, physician and theologian. By combining three vast subjects Linacre epitomizes the intellectual mood of his time, the enthusiasm to add fresh and exciting detail to the theological universe. The Greek New Testament was as important to Linacre as Galen’s Hippocratic theories.
The recognition of the proper relation between religion and medicine is illustrated in Simon Kellwaye’s medical treatise, A Defensative against the plague (1593). The author quotes from Ecclesiasticus on the title page, ‘God hath created meddesens of the earth, and he that is wise will not contemne them.’ A similar association between religion and medicine is found in John Jones’s work The Bathe of Bathes Ayde (1572) and The Arte & Science of preserving Bodie and Soule in Healthe, Wisdome, and Catholike Religion (1579). The works are dedicated to Queen Elizabeth because the ruler is seen as the divinely inspired protector of medicine through her rank in the universal chain.
Sir Thomas Elyot’s Regimen Sanitatis Salerni (1541) was made for ‘the most noble and victorious kyng of England, and of France’. Elyot was not a physician by profession, but his reading of Galen and other ancient medical writers and his early association with Linacre inspired a medical essay ‘The Castel of Helth’ (1534). The elaboration of the humoral theory takes a marked step forward in his work, but the link with the original ancestry remains unbroken. Elyot explores the elemental Hippocratic system, the qualities of the four elements, the purifying role of Fire and introduces a new word Complexion to describe the dual composition of each element:
Combination of two dyuers qualities of the foure elements in one bodye, as hotte and drye of the Fyre: hotte and moyste of the Ayre, colde and moyste of the Water, colde and dry of the Earth.82
In this way, all four elements with their assigned qualities would be present in any person, but would be defined either as Sanguine, Fleumatike, Cholerike or Melancolyke depending on the signifying qualities. Each complexion was given a list of medical as well as emotional characteristics. This suggests a new and more conscious psychological approach to the old theory. The sanguine complexion would develop from the hot and moist element Air. Among the idiosyncrasies of the sanguine person were ‘flesshynesse, plenty and redde hair, the visage white and ruddy’ and he was likely to experience ‘dreames of blouddy thynges, or thinges pleasdant’ and he would be ‘angry shortly’. The phlegmatic complexion would arise from the cold and moist element Water and a man dominated by this complexion would show signs of ‘fatnesse, slownesse, dulnesse in learning’ and ‘slownesse of courage’. The choleric complexion came from the hot and dry element Fire and this mix would create ‘leannesse of body, blacke or darke aburne curled hair’, the person would get ‘lytell sleape’ and would