Enthousiaste The doctrine of the four humours. In the order stated above—not necessarily following one another, but often existing side by side—these various meanings evolved in the course of a development covering more than two thousand years. Although new meanings emerged, old meanings did not give way to them; in short, it was a case not of decay and metamorphosis, but of parallel survival. The original basis of the different meanings was the quite literal conception of a concrete, visible and tangible part of the body, the “black bile” (atra bilis), which, together with the phlegm, the yellow (or “red”) bile, and the blood, constituted the Four Humours. These humours corresponded, it was held, to the cosmic elements and to the divisions of time; they controlled the whole existence and behaviour of mankind, and, according to the manner in which they were combined, determined the character of the individual. “Sunt enim quattuor humores in homine, qui imitantur diversa elementa; crescunt in diversis temporibus, regnant in diversis aetatibus. Sanguis imitatur aerem, crescit in vere, regnat in pueritia. Cholera imitator ignem, crescit in aestate, regnat in adolescentia. Melancholia imitatur terram, crescit in autumno, regnat in maturitate. Phlegma imitatur aquam, crescit in hieme, regnat in senectute. Hi cum nec plus nec minus iusto exuberant, viget homo.” In these clear, terse sentences of an early medieval natural philosopher, we have the ancient doctrine of the Four Humours. This system was destined to dominate the whole trend of physiology and psychology almost until the present day; for what the “heterodox” schools of antiquity had opposed to humoral pathology was either forgotten or else merged into the orthodox doctrine by the second-century eclectics, especially Galen. In the same way Paracelsus’s objections went long unheard. This system can be accounted for only by the combination of three very ancient (and, in part at least, specifically Greek) principles: 1. The search for simple primary elements or qualities, to which the complex and apparently irrational structure of both macrocosm and microcosm could be directly traced. 2. The urge to find a numerical expression for this complex structure of bodily and spiritual existence. 3. The theory of harmony, symmetry, isonomy, or whatever other name men may have chosen to express that perfect proportion in parts, in materials, or in faculties, which Greek thought down to Plotinus always regarded as essential to any value, moral, aesthetic or hygienic. In seeking, then, to ascertain the origin of humoralism, we must go back to the Pythagoreans, not only because the veneration of number in general attained its highest expression in Pythagorean philosophy, but more particularly because the Pythagoreans regarded the number four as specially significant. They used to swear by four, “which holds the root and source of eternal nature”; and not only nature in general, but rational man in particular, seemed to them governed by four principles, located in the brain, the heart, the navel and the phallus respectively. Even the soul was later on envisaged as fourfold, enclosing intellect, understanding, opinion and perception. The Pythagoreans themselves did not evolve a doctrine of four humours, but they prepared the ground by postulating a series of tetradic categories (such as, for instance, those already mentioned; earth, air, fire and water; spring, summer, autumn and winter). In this system, once it was evolved, the four humours could easily be accommodated. Above all, they defined health as the equilibrium of different qualities, and sickness as the predominance of one—a concept truly decisive for humoralism proper. Alcmaeon of Croton, a Pythagorean doctor who lived about 500 B. C., declared that “equality of rights between the qualities moist, dry, cold, hot, bitter, sweet, and the rest, preserved health, but the rule of one among them produces sickness”; and he condensed the notion of health into the formula “a well-balanced mixture of the qualities”. Whereas Alcmaeon left indefinite the number and nature of the qualities whose isonomy constituted health (“moist, dry, cold, hot, bitter, sweet, and the rest”), Philolaus took a step forward towards humoralisrn by describing the number four as “the principle of health”. The emergence of a thoroughgoing doctrine of humoralism required, however, the fulfilment of three further conditions. First, the Pythagoreans had venerated four as being a perfect number. It was now also given a physical content; this was achieved when the Pythagorean number symbolism was transformed into a doctrine of the cosmic elements. Secondly, each of these four elements had to be interpreted in terms of a quality which established, as it were, an apparent link between the original elements and the corresponding components of the human body which could not, in their empirical actuality, be regarded as pure earth, pure water, and so on. Thirdly, certain real substances which appeared to correspond to those elements and qualities had to be found in the human body, for only then could the speculations of natural philosophy be reconciled with the empirical evidence of medicine and physiology. Enthousiaste# The doctrine of the four humours. In the order stated above—not necessarily following one another, but often existing side by side—these various meanings evolved in the course of a development covering more than two thousand years. Although new meanings emerged, old meanings did not give way to them; in short, it was a case not of decay and metamorphosis, but of parallel survival. The original basis of the different meanings was the quite literal conception of a concrete, visible and tangible part of the body, the “black bile” (atra bilis), which, together with the phlegm, the yellow (or “red”) bile, and the blood, constituted the Four Humours. These humours corresponded, it was held, to the cosmic elements and to the divisions of time; they controlled the whole existence and behaviour of mankind, and, according to the manner in which they were combined, determined the character of the individual. “Sunt enim quattuor humores in homine, qui imitantur diversa elementa; crescunt in diversis temporibus, regnant in diversis aetatibus. Sanguis imitatur aerem, crescit in vere, regnat in pueritia. Cholera imitator ignem, crescit in aestate, regnat in adolescentia. Melancholia imitatur terram, crescit in autumno, regnat in maturitate. Phlegma imitatur aquam, crescit in hieme, regnat in senectute. Hi cum nec plus nec minus iusto exuberant, viget homo.” In these clear, terse sentences of an early medieval natural philosopher, we have the ancient doctrine of the Four Humours. This system was destined to dominate the whole trend of physiology and psychology almost until the present day; for what the “heterodox” schools of antiquity had opposed to humoral pathology was either forgotten or else merged into the orthodox doctrine by the second-century eclectics, especially Galen. In the same way Paracelsus’s objections went long unheard. This system can be accounted for only by the combination of three very ancient (and, in part at least, specifically Greek) principles: 1. The search for simple primary elements or qualities, to which the complex and apparently irrational structure of both macrocosm and microcosm could be directly traced. 2. The urge to find a numerical expression for this complex structure of bodily and spiritual existence. 3. The theory of harmony, symmetry, isonomy, or whatever other name men may have chosen to express that perfect proportion in parts, in materials, or in faculties, which Greek thought down to Plotinus always regarded as essential to any value, moral, aesthetic or hygienic. In seeking, then, to ascertain the origin of humoralism, we must go back to the Pythagoreans, not only because the veneration of number in general attained its highest expression in Pythagorean philosophy, but more particularly because the Pythagoreans regarded the number four as specially significant. They used to swear by four, “which holds the root and source of eternal nature”; and not only nature in general, but rational man in particular, seemed to them governed by four principles, located in the brain, the heart, the navel and the phallus respectively. Even the soul was later on envisaged as fourfold, enclosing intellect, understanding, opinion and perception. The Pythagoreans themselves did not evolve a doctrine of four humours, but they prepared the ground by postulating a series of tetradic categories (such as, for instance, those already mentioned; earth, air, fire and water; spring, summer, autumn and winter). In this system, once it was evolved, the four humours could easily be accommodated. Above all, they defined health as the equilibrium of different qualities, and sickness as the predominance of one—a concept truly decisive for humoralism proper. Alcmaeon of Croton, a Pythagorean doctor who lived about 500 B. C., declared that “equality of rights between the qualities moist, dry, cold, hot, bitter, sweet, and the rest, preserved health, but the rule of one among them produces sickness”; and he condensed the notion of health into the formula “a well-balanced mixture of the qualities”. Whereas Alcmaeon left indefinite the number and nature of the qualities whose isonomy constituted health (“moist, dry, cold, hot, bitter, sweet, and the rest”), Philolaus took a step forward towards humoralisrn by describing the number four as “the principle of health”. The emergence of a thoroughgoing doctrine of humoralism required, however, the fulfilment of three further conditions. First, the Pythagoreans had venerated four as being a perfect number. It was now also given a physical content; this was achieved when the Pythagorean number symbolism was transformed into a doctrine of the cosmic elements. Secondly, each of these four elements had to be interpreted in terms of a quality which established, as it were, an apparent link between the original elements and the corresponding components of the human body which could not, in their empirical actuality, be regarded as pure earth, pure water, and so on. Thirdly, certain real substances which appeared to correspond to those elements and qualities had to be found in the human body, for only then could the speculations of natural philosophy be reconciled with the empirical evidence of medicine and physiology. Enthousiaste