Feeling Humorous?

You might not have heard of humoralism, but I bet you’ve heard of the four humors.

Some 2400 years ago in ancient Greece, Hippocrates laid out the idea that there were basic substances in the human body that he called humors. These were fluids that needed to remain properly balanced, and whenever there was too much or too little of one or the other, people got sick or died.

Galen, working a few centuries later in Rome and building off of Hippocrates’s ideas, came up with the concept of the four humors (blood, phlegm, yellow bile, black bile).

Galen’s idea was that these four fluids had to be in balance, so it was easy to have too much of one.

Those four humors really stuck with Western medicine, all the way into the modern era. Think of barber shops with those striped poles out in front of them—they were not just for getting your hair cut.

Those iconic red and white stripes might make you think of a candy cane. I know that’s what I saw as a kid whenever my folks would drive past one of these landmarks.

The truth is that they represent bandages hanging in the wind. Yes, the red represents blood.

One of the main things you’d see the barber for? Bloodletting, of course. Blood is the first of the four humors, and probably the one you’re most familiar with.

Then, there’s bile. Actually, according to Galen, there are two types of bile, as we discussed in A Gallon of Gall:

Black and yellow bile, by contrast, were less obvious. If you’ve ever puked, you’re familiar with yellow bile. That yellowish stuff at the end, when everything else is gone? Yep.

Black bile, though, is pretty much just something Galen made up. Well, not really—Hippocrates and others before him had identified something they thought was a distinct substance, and Galen had systematized it—but it’s not really a thing in the human body in the same way that yellow bile or blood is.

Okay, so we have the very real blood and yellow bile, and the very made-up black bile. That’s three of the four humors.

For the grand finale, we have phlegm. What a great word!

Phlegm, by contrast with black bile, is a very real thing in modern anatomy and medicine—but it might not be exactly what you think.

When you breathe in, you inadvertently bring lots of dust particles and other gunk in with your precious air. Specialized cells in your trachea and airways notice these particles and respond by producing mucus, and so it coats the particles on the way into the lungs. That way, you can cough out the crud stuck in there.

The thick gunk is called phlegm. Galen thought it slowed you down, and I can see why. That’s where we get the word phlegmatic. He also thought phlegm made you cool-headed and steady, so you can sort of see the logic if you squint.

Blood was what made you go. If you were hot-blooded, you were excitable and agitated. You needed calming down, so bloodletting was one way to balance this humor.

Yellow bile made you irritated or angry. This is what induced Lincoln to say:

A drop of honey catches more flies than a gallon of gall.

Black bile, by contrast, makes you depressed or gloomy.

None of this is true, of course. Modifying the proportions of blood, phlegm, and bile in your body doesn’t really fix anything, and germ theory finally overthrew the humorous theory only around the late 1800s.

Let me end today on that note. The past isn’t as past as we might think—we still use phlegmatic and hot-blooded, and talk in terms of having a lot of gall. That’s largely because most people in the West still believed this stuff up until fairly recently.