Thoughts on Medicine: Humoural Theory

[Wolfie]

Urth, as our helpfile on medicine states, does not have the comfort of modern medicine. Though it is difficult to approximate pain, suffering and trauma associated with the humoural system through a game, I wanted to provide some perspective on the subject as one of the few doctor characters that we’ve had over the years.

As most of you know, I run Rasim. He is based off of a first millennium Muslim polymath by the same last name, Alhazen. Rasim’s education as a young man revolved around the domain of ‘physic’ or natural philosophy. There was no hard science at the time, and indeed, because of religious limitations most education comes in the context of theology. Afterwards, at the age of 16, he entered the field hospitals on the Marches until he became known as a ‘master’ surgeon.

What is the state of the art of medicine in Lithmore? It is not an easy question to answer, as our timeline is a wonderful hodgepodge of real time periods, regional influences and player manifested ideas. I am going to put forward a few ideas on the state of the craft with the preface that Rasim, and therefore I, may be slightly ahead of the times in terms of thinking or even behind in some areas. I, like my characters, prefer heady theory, so let's start with that.

As the helpfile says, there are three things you can do when your player is sick.
1) Visit a priest, get the bad spirits exorcised.
2) Visit a doctor, get your humours balanced.
3) Visit an herbalist, get a folk remedy.

What are humours?
The word humor comes from Latin, meaning fluid or moisture, but in terms of its usage in the humoural system, it seems to include all things that have transitive properties, composed of air, water or any combination. If it can be felt to flow, possesses some value of temperature and has to do with the body then we might consider it a humor. This, then, does not limit humors to people, but also includes plants and animals.
Most will be familiar with the four primary humours based upon the primary elements: Fire, Air, Water and Earth translates to Yellow bile (Choler), Blood, Phlegm and black bile (Melancholy).

To draw from Robert Burton’s 1628 manual, The Anatomy of Melancholy,
“Blood is a hot, sweet, temperate, red humour, prepared I the meseraic veins [small veins that bring the chylus to the liver], and made of the most temperate part of the chylus in the liver, whose office is to nourish the whole body, to give it strength and colour, being dispersed by the veins through every part of it. And from its spirits are first begotten in the heart, which afterwards by the arteries are communicated to the other parts.
Pituita, of phlegm, is a cold and most humour, begotten from the colder part of the chylus, in the liver; his office is to nouish and moisten the members of the body which, as the tongue, are moved, that they be not over-dry.
Chloer is hot and dry, bitter, begotten of the hotter part of the chylus, and gathered to the gall; it helps the natural heat and senses, and serves to the expelling of excrements.
Melancholy, cold and dry, thick, black and sour, begotten of the more feculent part of nourishment, and purged from the spleen, is a bridle to the other two hot humours, blood and choler, preserving them in the blood, and nourishing the bones.”

The last humour, chylus, was mentioned briefly above and all other humors sublimate from it. Chylus is a white liquid that originates in the stomach when breaking down food, especially meat. Sublimation is an important elemental ‘fact’ that will later help explain some of our philosophies.

Burton also attributes these four humours and elements to another popular ‘four’ of the day, the Four Ages of Man. Childhood, youth, maturity and old age, or in Greek terms the Golden, Silver, Bronze and Iron Ages of Man. While region generally determines the composition of innate humors (the balance which they were born with and needs to be maintained for health), physicians will also note that he stage of life will also change the temper. Young people are ‘spleenful’ and elderly people are ‘melancholic’ for their dryness and coldness.

Why must humours be kept in balance? Humours, by themselves, contain good and bad elements.
Blood – Air – Art, Courage, Hope, Amourous
Yellow Bile – Fire – Passion, Easily Angered
Melancholy – Earth – Despondent, Sleepless, irritable
Phlegm - Water – Rationality, Calm, Unemotional.

By working these against each other, a person would be on an even keel. The rationality of Water tempers Fires passion. The Hope of Air keeps the depression of Earth at bay. Imbalances are dangerous. Overproduction of one or the other would cause an abundance of the element in the body and therefore the moods that it controls. Too much blood makes you lusty. Too much yellow bile makes you angry. Too much water could make you so calm that you stop breathing. Cold could become hot, hot could become cold.

Where do the elements fit in to every day philosophy? While I won’t touch upon the creation of the world or any of the mythology around it here, it is understood by educated people that the world is composed of elements. Each entity, object or person is composed of the four primary elements and the fifth element which is usually up for debate, either being Ether for scholars or Void for mages. The four elements are divided into two groups: chthonic and celestial.

The Chtonic elements are earth and water. They are both characterized by their weight and their cold temperature. Because of this, these elements in their pure forms and in the abundance in earthly forms, create the bulk of the world. These are the meat and potatoes of Creation.

The Celestial elements are air and fire. They are both characterized by their lightness and their warmth. They are transient elements, known more for their passing than their presence.

Transmuting elements is something reasonable for a natural philosopher. You can easily turn water into steam by heating it. Earth, being heaviest, is probably the most difficult to turn into anything of use save through farming or the nearly magical craft of blacksmithing.

Natural transmutation happens constantly. Fire and air are more susceptible for their heavenly affinity. Their natural ‘rising’ tendency leads philosophers to believe that they further sublimate into Ether, the element of the stars and the soul. Earth, the element of melancholy, has a great significance as well, being an element that is usually seen as nothing but bad. However, because of what has historically come out of the earth, a large number of philosophers attribute it to deep inspirational understanding on a near divine level. Again, agriculture and blacksmithing live in this domain.

So what do chthonic and celestial affinities have to do with medicine? My usual example of their relationship relates to the theology of the body and the soul. A faithful person, who should make up the majority of the total NPC/PC population, would know that there are souls. The medieval world, unhindered by the advances of the Renaissance and over-abundant Reason would be filled with souls. People had souls, animals and plants had lesser souls. Mountains and rivers have their spirits, too.

In some forms of Davite theology the path of life and all of its tribulation is illustrated in terms of a vessel carrying Waters from the Wellspring. The corporeal body, though imperfect in its temporality, carries within it a fragmentary draught from the headwaters of Creation.

The soul is that fragment of divinity. Its purity and eternal nature help to keep the body whole by fighting corruption (infection) and facilitating natural healing. If the soul is corrupted, its seat within the body will allow it to corrupt the flesh that in inhabits. The inside mirrors the outside, and vice versa. An imbalance of the humors (the corporeal components compared to the divine of the soul) may also slowly corrupt the eternal light within. The interplay between body and soul is very important.

A good illustration of this is when a man dies. Death is when the spirit leaves the body permanently. The vigor and animation are gone. There is no brightness to the eyes. No divine spark characterized by speech or wit. In this case, the chthonic and celestial elements separate out, as they naturally tend to. A medieval doctor would explain the rot of cadavers by saying that there is nothing to preserve their purity. Without aid of the spirit, the body returns to its natural state of water and earth.

I still need to go into detail in regard to treatment regimes, surgery, pain, herbalism and associated advancements in compounding/distillation/poisons.

[wimple]

I can't seem to find any of my old files for Aly, but from what I remember:
When you were born (the season) also played into it which humour you were naturally inclined towards. So does the time of the year, so if you're particularly, say, sanguine, and it's the sanguine time of year, then you run the risk of being crazy sanguine in personality.

Foods and bloodletting both combat the humours. Different parts of the body (you can find images of wound men that give locations) when bloodlet will affect different humours, draining the body of them. Foods and drinks - anything that is consumed - will cause humoural shifts as well. So by bloodletting and eating a certain diet (a meal could have many parts, something to open the stomach, a course of a certain type of vegetable, a certain type of meat, a digestive to close the stomach, etc.) one could keep one's humours in balance.

These sorts of things were HEAVILY monitored by people on a day to day basis. A noble with a child? You want to make sure your son is choleric and not melancholic; you will feed him foods and monitor his diet to make sure this happens, but make sure he doesn't turn TOO choleric and into a madman. You are a merchant wanting your family to be on the rise? Make sure your children are snaguine, so they will be popular, and marry up. Etc.