HUMORISM

Sure, all the other chapters have been gut-busters, but this one is guaranteed to leave a stitch in your side.

Get your funny bone ready for a hilarious tour of all the zaniest ways we’ve tried to use great jokes to treat all manner of illness as we prove laughter truly is the best medicine. Also, we’re probably gonna talk about Patch Adams, so it’s time to get psyched!

. . . I was alerted just now by my wife that this chapter has nothing to do with humor, and is about something else entirely. I deeply regret this error, caused by a sadly unavoidable occurrence of me writing the opener before I read the chapter. I would also like to apologize for my unwillingness to edit the above text to reflect the actual content of this chapter. This situation was also unavoidable, as it was a lot of words ago, and I am a very busy man.

The idea that every individual’s health, wellbeing, and even personality are determined by the balance of essential bodily fluids, or humors, is one of the oldest in history. There are indications that these beliefs got their start in ancient Egypt, or maybe Mesopotamia, but it took the ancient Greeks to turn those ideas into a comprehensive system of diagnosis and treatment. This system was incredibly long-lived; in fact, it formed the foundation of most medical thought all throughout Europe until the 19th century. On the Indian subcontinent, Ayurvedic medicine took a similar approach for millennia, and is followed by many today.

It would be natural to assume that an idea that spanned both time and geography to such an extent must be correct. However, as devoted students of medical history, we can tell you that being wrong never halted a concept if the doctor behind it just said it loudly and with confidence. Alongside “do no harm,” those old-timey doctors probably should have embraced the motto “always certain, but rarely right.”

ANYTHING THIS SIMPLE HAS TO BE TRUE . . . RIGHT?

One very attractive facet of humorism is its simplicity. All you really need to know is that there are four fluids within the human body that must be balanced in order to maintain physical and mental health. These fluids, or humors, are created in the liver as the products of digestion, and then stored in various organs. You’re probably wondering what the four humors are, but please, be patient. First, we’ve got to lay a little blame.

The first iterations of medical humorism may have come from Hippocrates, or his son-in-law, Polybus of Cos, but it was brought to real prominence and further defined by the Roman physician and philosopher, Galen of Pergamon. The actual nature of the four humors and their individual significance was a product of Galen’s many writings.

So wait, Hippocrates or maybe Polybus didn’t even say what the four humors were? He was just like, “Hey yo, check this out: There are four liquids running everything. They’re in your tummy or whatever. I don’t know what they are yet, but I’m totally right on this one. Trust me on it.”

It’s pretty clear that Galen approached humorism as a theory, attempting in his writings to flesh it out with detail based on his understanding of the human body. However, once Galen was no longer around to properly explain things, many of his followers began to take his idea as absolute fact. This galvanized the humoral theory and would make it unshakable for many years to come.

. . . OR NOT. POSSIBLY NOT.

In fact, the theory of humorism remained much the same for over a thousand years, and in many traditions. Each humor was thought to have healing or harmful properties based on their associated temperature and moisture content. Balancing out the humors usually involved working to improve or counter these various properties, based on the patient’s condition.

THE FOUR HUMOURS

Okay, so, you’ve waited long enough! Here are the four humors. Enjoy!

PHLEGM

Cold and Wet
Stored in the brain and lungs
Helps the body purify itself
Element: Water
Season: Winter
Age: Old age
Temperament: Phlegmatic

YELLOW BILE

Warm and Dry
Stored in the spleen
Helps with digestion
Element: Fire
Season: Summer
Age: Youth
Temperament: Choleric

BLACK BILE

Cold and Dry
Stored in the gallbladder
Used by the body to make bones, teeth, and connective tissue
Element: Earth
Season: Autumn
Age: Adulthood
Temperament: Melancholic

BLOOD

Warm and Moist
Stored in the liver
Contains a vital essence
Element: Air
Season: Spring
Age: Infancy
Temperament: Sanguine

A LITTLE HARD TO SWALLOW

Before we go further, none of this will make sense unless you know that we really didn’t understand digestion at all for much of history. The ancient Greeks believed that digestion happened in four totally separate phases.

Phase one was supposed to take place in the stomach, resulting in formation of stool (which is to say, poop, in case that wasn’t clear.)

Phase two was a big deal—it happened in the liver, and produced all four of the humors.

Phase three happened in the blood vessels, producing urine and sweat.

Phase four was your body’s chance to get rid of any last “abnormal humors,” passing them from the body as ash.

In phase two, the humors were supposedly created in order of importance. First nutrient-rich blood, followed by a whole lot of phlegm to keep the respiratory system running smoothly. Then, a little yellow bile to keep the digestion going right, and finally, a very small amount of black bile for our bones.

You may be wondering why no one just investigated this theory by simply taking a peek under the hood of a cadaver and seeing if the humors were, you know, there. It seems obvious to us super-smart modern folks that a simple examination would have proven that humorism was not actually based in fact, and instead just made up from whole cloth.

If you believe the theory Swedish physiologist Robin Fahraeus put forth in the 1920s, they totally did. You see, if you draw blood from a vein and then let it sit out in a container for a bit, it’ll separate out into layers. A dark clot will form at the bottom, followed by a layer of red blood cells above that, a whitish layer of white blood cells above that, and finally, a layer of yellowish serum at the top. There are your humors.

It’s a tempting theory that would account for the sustained belief in the existence of the four humors. However, since the creation and spread of humorism predates blood draws and test tubes, it may be a bit of a stretch.

DON’T LOSE YOUR BALANCE

Each humor had specific qualities associated with it, both good and bad. The key to good health was thought to be keeping them in proportion. Of course, the right balance was thought to be different for every person—that extra helping of black bile that makes me so thoughtful and deep might just make you sad and lonely. Achieving the correct balance was partially just trial and error, and even if you did hit that perfect fluid equilibrium, you could throw it off again with the wrong diet or exercise routine.

The essence of medical care in the age of the four humors, then, pretty much boiled down to eating and drinking things and taking medications that would crank selected humors up or down in your body. Your prescription would be based on the temperature and moisture of the humor that was out of balance. So for example, eating cold foods were thought to make you produce extra phlegm, while hot foods would get you a nice healthy dose of yellow bile.

All that tinkering with your diet a little too low-key? Good news. Common wisdom was that the best way to get rid of whatever excess humor was getting your down was to expel it from the body as efficiently as possible. Bloodletting, obviously, was the best way to relieve excess blood. Diuretics would get rid of excess phlegm, and laxatives and emetics (stuff that makes you puke) could help clear out extra black or yellow bile. As a result of this theory and manner of treatment, a physician was very much a dietician as well, telling you what to or what not to eat based on your humor levels.

JUSTIN VS SYDNEE

SYDNEE Not only was this treatment easy to explain to patients, it played to one of the major strengths of early physicians that has persisted throughout medical history. Doctors know how to make you poop and puke. Even before we understood why or how or if we should do these things, we definitely had a full armory of noxious herbs and chemicals that would clean you out from one end or the other. As an added bonus, the patient never needed to be convinced that the prescription they were given was working because they always knew. God help them, they knew.

JUSTIN . . . Wow, Syd. It’s really inspiring company you’ve thrown your lot in with. I always wondered when your class had to recite the Hippocratic Oath, what the line “And I shall take it to the limits of nastiness, twenty-four seven” was in reference to, but I think I’m starting to get it.

SYDNEE You can laugh all you want, but my particular set of skills may just save your life someday. Or at least your weekend.

JUSTIN Because I’d be . . .

SYDNEE Constipated, right.

It wasn’t all diet, exercise, and leeches. Sometimes, things got really serious. If you had the plague, for example, you had too much of all of your humors in general, so arsenic was good for clearing out all that excess.

Arsenic would not be good for that. Or for anything, really. Unless, by clearing out excess humors, you mean dying. Arsenic would actually be good for that.

Remember how we mentioned above that the humors weren’t just supposed to affect your health, but your personality as well? Changes in humors were thought to explain changes in temperament or moods. It was thought that everyone was sort of guided by one humor or another and that it dominated the way they behaved and interacted with other people. But which excesses led to which temperaments?

Here’s a way to remember the humors, by the third-tier Simpsons character they remind us most of.

Black bile Too much of this yucky stuff supposedly caused depression, as well as melancholic temperament. That’s sad sack bartender Moe Szyslak for sure.

Yellow bile An overabundance of yellow bile was said to cause anger or derangement, and a choleric, irritable temperament—clearly what drove Sideshow Bob to a life of crime.

Phlegm Too much phlegm caused you to be apathetic, which is pretty much Mrs. Krabappel all over.

Blood Probably the only good humoral side effect on our list, too much blood led to a carefree, happy sanguine temperament. After two hours of contentious debate, we’re declaring it a tie between Disco Stu and Doctor Nick Riviera, in the hopes of preserving our marriage.

YOUNG, DUMB, AND FULL OF BILE

In the diagram above, you’ll see that each humor is also associated with a stage of life. The thinking went that, while each individual may have a guiding humor through all of their days, different phases of life were connected to each of the humors as well. You start out sanguine when you are a child, and you are filled with a lot of blood. The teenage and young-adult years are full of passion and upheaval from your new choleric temperament. When you become an adult, you start to worry about stuff, and you are depressed and melancholic. (We can vouch for this one.) Then you get old and kinda say “screw it.” You are at peace with it all and have become phlegmatic.

These “medical” definitions bled into works of popular culture at the time. It wasn’t uncommon for theatrical characters to be introduced as having temperaments related to humors. In The Taming of the Shrew, for example, Katherine is kept from eating a calf foot because it’s too “choleric” a food, and she’s already grouchy.

DO WE STILL DO THIS TODAY?

Short answer? No. These concepts are deeply woven into European languages and literature, but medical science has moved on. Notably, some alternative treatments touted even today have their roots in the humoral system. A good example of this is “cupping.” While Olympic athletes may do it because they believe it increases blood flow to certain tissues, it was practiced through much of history because of its perceived ability to migrate the humors around in the body.