Mini-Episode: The Four Humours
Today we have a new mini-episode for you!
In these mini-episodes, we’ll be exploring topics that are related to Shakespeare but aren’t necessarily connected to whatever play we’ve been discussing.
And they’re mini, because well, they’re shorter than our other episodes. They’re like quartos if the regular episodes are folio editions.
In today's episode, we are exploring the Four Humours, which were a widely held theory in medicine during Shakespeare's time and which are referenced throughout his works!
Transcript:
Kourtney Smith (KS): Welcome to another Shakespeare Anyone mini-episode! In these mini-episodes, we’ll be exploring topics that are related to Shakespeare but aren’t necessarily connected to whatever play we’ve been discussing.
Elyse Sharp (ES): And they’re mini, because well, they’re shorter than our other episodes. They’re like quartos if the regular episodes are folio editions.
KS: In today’s mini-episode, we’ll be covering the Four Humors! Quick warning--we will be discussing some bodily functions and historical medical practices in today’s episode, so listen with caution if these types of topics aren’t for you.
ES: Now, what exactly are the four humors? No, they’re not an epic clan of comedians. They’re actually an antiquated medical theory that attempted to explain the human body as well as disease, psychology, habit and personality at a time when doctors and physicians were trying to figure out why our bodies and minds functioned as they do. The four humours are blood, yellow bile, black bile and phlegm--they are four internal juices that have to be in perfect balance for a perfect body, mind and mood. And Shakespeare references these humors a lot.
KS: Here are just a few examples -- Blood makes one sanguine, or happy, lucky, and lustful--which is a pretty good description of Falstaff, or as Prince Henry describes him in Henry IV Part One, Act II Scene IV: “This sanguine coward, this bed-presser, this horse-back-breaker, this huge hill of flesh.” In this line, Prince Henry is basically using the word “sanguine” to describe Falstaff as an extrovert. Being described as sanguine tells the audience that Falstaff is so happy and excitable that he’s reckless.
ES: Yellow bile makes one have a choleric, or angry, irritable, temperament and is referenced in Cymbeline Act II Scene V: “This yellow Jachimo, in an hour--was’t not?--/Or less--at first?” In this line, Posthumous Leonatus describes another character, Jachimo, of having too much yellow bile, making him choleric, or short-tempered.
KS: Yellow bile can also been seen in Petruchio’s treatment of Kate in The Taming of the Shrew--dragging her through cold and wet weather after their wedding, not allowing her to eat mustard or burnt meat, and lecturing her on continence can all be read as treatments for a bad case of choler.
ES: Black bile makes one melancholic, or over-analytical, nervous and a deep thinker, and is referenced in Love’s Labour’s Lost in Act I Scene I: “So it is, besieged with sable-coloured melancholy, I did commend the black-oppressing humour to the most wholesome physic of thy health-giving air; and, as I am a gentleman, betook myself to walk.” In a letter read by the king, Armado says he was so trapped by melancholy that he decided to combat the black-opressing humor by going for a walk. We’ve all done that right?
KS: And, of course, the infamous Hamlet is overcome by black bile, causing him to overthink, overanalyze and fall into a melancholy, or depression.
ES: Lastly, phlegm makes one phlegmatic, or easy-going, quiet and agreeable but also a bit lazy, and is referenced in Merry Wives Act I Scene IV: “I beseech you be not so phlegmatic.” In this line, Mistress Quickly is addressing Dr. Caius and imploring him to not be so lazy.
KS: So, yeah, these four humors come up frequently in Shakespeare and, if you’re going to study his plays, it’s really beneficial to know them. That’s because he, his contemporaries and his audiences widely accepted this as common medical knowledge. In early modern England, the four humours were as basic to them as our acceptance that you should wash your hands after you sneeze, drink tea for a sore throat or treat a scratch with rubbing alcohol and a bandaid.
ES: The Four Humors, is also referred to as humourism, the humoural theory and humouralism, and, like we said, it was a medical (and now, you can’t see it, but there’s definitely air quotes being used here) theory that was used to explain disease, psychology, habit and personality for over 2,000 years! Yes, 2,000. The four humours were used either exclusively in medicine or alongside other ideas in Western civilization starting with the ancient Greeks up until the end of the 19th century.
KS: The Four Humors trace their origins back to Aristotelian biology and physics. The first codified mention of the theory of the humors can be found in the Hippocratic Corpus, a collection of 60 medical works associated with the ancient Greek physician, Hippocrates, who is considered the Greek Father of Medicine. The specific section that details the humors is On the Nature of Man and is attributed to Polybus, Hippocrates’ student and son-in-law.
ES: In this text, the author ties the four humors to seasons of the year and stages of lifES: blood is warm and humid, like springtime; yellow bile is hot and dry, like summer; black bile is dry and cold, like autumn; and phlegm is cold and wet, like winter. And as for stages of life, he doesn’t really get too into that. But according to the treatise, “Health is primarily that state in which these constituent substances are in the correct proportion to each other, both in strength and quantity, and are well mixed. Pain occurs when one of the substances presents either a deficiency or an excess, or is separated in the body and not mixed with others.”
KS: But this idea that you need balance in your body was not exclusively Greek. The four humors are similar to theories from the ancient civilizations of China and India where it was believed that your body is influenced by a temperament of elements. But, instead of seasons, these two civilizations tied what we call the humors to the elements: air instead of blood; fire instead of yellow bile; earth instead of black bile; and water instead of phlegm. And of course there were other theories and medical practices taking shape in other regions in the world, like Africa, Eastern Europe, the Americas and other parts of Asia and the Middle East. However, this mini-episode is dedicated to the Western European-centric four humors as it pertains to William Shakespeare and his part of the world. So, alas, that is a topic for another podcast.
ES: Moving right along… In the second century, the Roman physician and philosopher, Galen wrote a commentary on On the Nature of Man where he expanded the theory. He connected the humors to stages of life and the elements, and established the frame of the idea that the humors could influence a person’s character. He wrote with absolute certainty that the four humours was complete fact and was incredibly successful at nit-picking at his opponents’ theories. He was such a successful doctor that he became the empress physician in the second century CE. While his addition to the four humours was game-changing, it wasn’t until several centuries later that the humors and their effect on character would be further developed into the four temperaments: sanguine, bilious (or choleric), melancholic, and phlegmatic. In other words, the language we often hear in Shakespeare.
KS: According to Noga Arikha, Visiting Fellow at the Institut Jean-Nicod in Paris, Galen’s medical analysis of the humours was expanded to explain our temperament. And everyone is born with a different temperament. But our temperament is not permanent. It can change. Different times of the day correspond with a different humoural state. Men and women have different humoural complexions. Children’s brains are supposed to be warm and moist which accounts for their ability to learn. And, according to David Wooton, Anniversary Professor of History at the University of York, animals, plants and minerals were also identified as having specific temperaments -- for example, cats were melancholic, so Elizabethan cats are usually depicted miserably due to their melancholy.
ES: We don’t see any major changes in the four humours until the establishment of the first and (arguably most important) medical school Schola Medica Salernitana, in Italy during the 9th and 10th centuries. By the 13th and 14th centuries, many Western European universities incorporated the study of medicine into their curriculum. These schools were influenced by Arabic medical treatises from Sicily and North Africa that were translated into Latin and invigorated the teachings of Hippocrates, Galen and others. But don’t get us wrong, Galen’s four humours was still the dominant concept taught in these institutions. And... not much changes until the middle of the 15th century -- right before our Tudor Dynasty! -- when physicians begin to participate in careful anatomical dissection and begin to study the details of the construct of the human body. This ends up showing physicians that Galen, in lots of details, is actually wrong. Shocking.
KS: But remember, we still have to give Galen credit for recognizing the fluids in our body. They just didn’t function or work the way in which he, so self-assuredly, claimed. Even though Galen was really wrong… physicians didn’t throw away the four humours. Instead, they continued to diagnose and practice on patients with the four humours at the forefront of their medical expertise. So, what does all of this mean? Like, if I were a Londoner in early modern England and I was feeling under the weather, what would the four humors mean for my medical treatment?
ES: Medical professionals of the time thought that when your body was lacking or overflowing with one humor, you had to restore it back to a balance. If you were an Elizabethan or Jacobean doctor in London, your medical training told you that you could take some blood from a patient and put it in a cup, let it sit for a while, and the blood would separate into these four humours. Urine was also used by empirics, or the unlicensed and local doctors, to read your humours in order to diagnose you. Doctors would read your blood or your urine and go from there.
KS: Let’s break it down: too much blood will make you happy, over-sexed, possibly gullible, but generally lucky. Yellow bile causes you to be angry, perverse, passionate, given to fury, and unlucky. Too much black bile causes depression and melancholy and accompanies misfortune and old age. And Phlegm makes you slow, lethargic, indolent, and stupid but fairly lucky.
ES: One medical practice that was used well before Shakespeare’s time and beyond it, was blood-letting, which by today’s standards sounds rather extreme, but it made sense to people of the time. If too much of one humor builds up in the body, you simply bloodlet, or let the excess drain off, to restore balance.
KS: So, yeah, bloodletting was considered a legitimate remedy for your ailment and it was a pretty calculated practice. There was a time and a place for treatments in different regions of your body for different ailments. Those tools were called bloodletting charts that would track specific bleeding sites on the body in alignment with the planets and zodiacs.Yes--astrology was actually a large portion of medicine throughout the time. Everything in nature was connected and doctors would perform bloodletting in regions of your body depending on these external factors and alignments.
ES: And if you’re freaking out while listening because it sounds like all the people throughout all the history until modern medicine would bloodlet to cure illness and ailments, that’s not entirely true. Bloodletting was incredibly popular, but so was diet and exercise. If you were a Medieval-era individual who was obsessed with your health and diet, you were in luck with the publication of the most important lifestyle and diet book of that period: The Regimen sanitatis Salernitatnum. It was written in the 12th or 13th century, or maybe as early as 1050, and was translated into almost every European language. So there were other options for dealing with an imbalance of your humours.
KS: You could also induce vomiting or induce diarrhea to remove excess substance. You can also cure with opposites by introducing more of something to find balance like dragging someone who has an excess of choler through a wet and cold environment to balance out the heat and dryness of choler. Treating melancholy was often as simple as getting the afflicted to have some fun--think of Feste in Twelfth Night trying to cheer up the mourning Olivia, or the effect that Touchstone has on the melancholy Jacques in As You Like It. Or Gertrude and Claudius inviting Hamlet’s school friends as a way to cheer up Hamlet, who they believe is just dealing with a bad case of melancholy.
ES: Now, we’ve talked a lot about the history of medicine in this episode. But let’s get back to Shakespeare. The language and references to the humors that informed audiences that the characters they were watching were dealing with humoral imbalance would have also been performance cues for the actors.
KS: When an Elizabethean audience would see an actor play a character like, say, Hamlet or Olivia, they would see an actor who understood exactly what it meant to embody melancholy. The actor would enter the stage and perform the role with this medical archetype in mind and the audience would recognize the physical signs -- much like a modern day audience may be very familiar with the trope of a character coughing blood into a handkerchief to signify that they have tuberculosis without anyone having to actually say it.
ES: Now, it’s easy to dismiss all of this as foolish. I mean, we certainly did up at the top of the show. But I want to say that, while the four humours clearly were not the best options for thinking about disease, psychology, habit and personality in retrospect, early modern England did a pretty okay job with the information they had available to them. Wounds were cleaned and bandaged. Diet and exercise were taken seriously. The internal juices of the body were acknowledged. However, they didn’t have antibiotics, knowledge of DNA, microscopic anatomy or other advancements in medicine and science. They might have done the best they could.
KS: But why did the acceptance of the four humours go on for so long, even as medicine and science was advancing well into the 19th century? Well, Wooton surmises that, even many physicians didn’t want to give up an explanation for your disease, psychology, habit and mood. The four humours provided people with direction in their life: what to eat, how to live, what to do. It was holistic. If we throw out Hippocrates, Galen and all the rest of the four humours, we must now work harder to figure out what truly explains everything about us, another theory. To go from the balance of the human body to infection requires a medical revolution. And that did happen: some 2,000 or so years after Hippocrates.
ES: Thank you for listening.
Quote of the episodes:
ES: From Twelfth Night, act three, scene one, said by Olivia, “A murd'rous guilt shows not itself more soon than love that would seem hid.”
Shakespeare Anyone? is created, written, produced, and hosted by Kourtney Smith and Elyse Sharp.
Our theme music is "Neverending Minute" by Sounds Like Sander.
Works referenced:
Cummings, M. J. (2018). The Four Humors in Shakespeare's Works. Accessed 5 Jan. 2021, from http://shakespearestudyguide.com/Four%20Humours%20in%20Shakespeare.html#:~:text=Examples%20of%20characters%20who%20exhibit,blood)%20in%20Much%20Ado%20About
DRAPER, JOHN W. “HUMORAL THERAPY IN SHAKESPEARE'S PLAYS.” Bulletin of the History of Medicine, vol. 35, no. 4, 1961, pp. 317–325. JSTOR, www.jstor.org/stable/44449750. Accessed 10 Jan. 2021.
Elliott, R. (2020, February 06). Bloodletting and the treatment of menstrual disorders. Accessed 13 Jan. 2021, from https://hekint.org/2020/02/06/bloodletting-and-the-treatment-of-menstrual-disorders-in-early-modern-england/
Galen: Selected Papers, by Jacques Jouanna and Neil Allies, Brill, LEIDEN; BOSTON, 2012, pp. 335–360. JSTOR, www.jstor.org/stable/10.1163/j.ctt1w76vxr.21. Accessed 29 Dec. 2020.
Kern Paster, Dr. Gail. “William Shakespeare and the Four Humors: Elizabethan Medical Beliefs by Dr. Gail Kern Paster.”
