Johns Hopkins Magazine
Johns Hopkins Magazine Current Issue Past Issues Search Get In Touch
The Inevitable Fate
By Geoff Brumfiel (MA '01)
Images courtesy Christine Ruggere, and the Institute of the History of Medicine

Christine Ruggere pulls a leather-bound volume off the shelf and opens it to an engraving of a human skull balanced on top of an hourglass. At the base, in Latin, is written: Inevitabile Fatum. "It's wonderful," murmurs Ruggere, curator of the Hopkins Welch Library's collection of Renaissance medical texts. "In all of these pictures they wrote: 'The Inevitable Fate'--just to remind you that you're going there, too."

The clergymen, scholars, and physicians who studied medicine during the Renaissance understood the inevitability of death. They lived in overpopulated cities where malnutrition and epidemics like the plague were part of everyday life, and where the average person lived to be only 30. The desire to understand the inevitable drove Renaissance scholars to study the human body. They learned Latin and Greek to translate ancient anatomical treatises, and traveled to Islamic kingdoms searching for lost medical texts. They condensed ancient knowledge into modern volumes and added their own observations based on human dissections. These texts became the only guides for university medical students and isolated village physicians, who depended on them to learn about the human body, disease, and treatment.

Several of the volumes reside in two vaults on the top floor of the Welch Library, home to one of the nation's most extensive academic collections of historical medical books-- some 10,000 volumes. The rare Renaissance works include several editions of Andreas Vesalius's De Humani Corporis Fabrica (1543) and an edition of William Harvey's extremely rare De Motu Corpus (1628), which presents the first theory of the blood's circulation.

By drawing on illustrations and information from these rare texts, magazine writer Geoffrey Brumfiel has put together the following "textbook"--sort of a Cliff Notes version of Renaissance Anatomy. We invite you now to journey back 500 years with Sir Geoffrey, to a time of gallantry, gout, fair maidens, and leeches...

Chapter I: Concerning the Humours

All those who have insight into natural philosophy know that the world is composed of four principal elements: Earth, Air, Fire, and Water. The combination of these elements in various proportion maketh all things, including human beings. Elemental qualities are conveyed through the body in the form of four humoral fluids: Blood, Phlegm, Black Bile, and Yellow Bile. Blood is both hot and moist, and like the spring season it conveyeth strength and vitality. Phlegm is cold and wet, and therefore associated with sluggishness. Black Bile (also called Melancholy) doeth hold the elemental qualities of coolness and dryness, while Yellow Bile those of hotness and dryness.

It is evident to the learned physician that a balance of humours doeth provide each human being with a unique personality, or Complexion. A sanguine person hath a preponderance of Blood, while an angry, bilious person holdeth an excess of Yellow Bile. A logical and phlegmatic person containeth a good deal of Phlegm, while too much Black Bile can cause melancholy. Women hath cooler, moister Complexions than men, which leave them shy and docile. Italians, who live in a warm, moist clime, are far more amorous than those who live in cooler, drier regions. And venerable old men are both cooler and drier, and therefore calmer and more reasonable, than the young.

Whereby the body gaineth motion: Vesalius's De Fabrica provided physicians with significant details of human anatomy, based on actual observation of dissected cadavers (oft suspended from poles, as at right, for better viewing). His eye to detail of musculature and the skeletal system improved greatly upon earlier anatomy works by Copernicus and Galen.

"Urine and other discharge are the means by which the Body restoreth its natural balance, and all physicians know that they are filled with clues and excess humours." In the body there lieth three systems for the manufacture and conveyance of humoral fluids. The Nutritive System breaketh down food in the Stomach and then conveyeth it to the Liver, where it is converted into a Sanguinous Mass composed of Blood, Phlegm, Black Bile, and Yellow Bile. The Mass, which holdeth the nutritive spirits necessary to sustain life, floweth out of the Liver through the Veins, and a portion floweth into the principal organ of the Vital System: the Heart. Inside the Heart, the Mass doeth mix with the air (that is drawn into the Heart by means of the Lungs) whereby it gaineth Vital Energy, which giveth the Body motion. The Vital Mass journeyeth out from the Heart into the rest of the Body by way of the Arteries. Some Vital Mass goeth to the Brain, the principal organ of the Animal System, where it be converted to Anima Spirits. These Spirits, which giveth the Body both sensation and coordination, traveleth outward through the Nerves.

Of melancholy and amour: The urine chart (at left) was thought to be invaluable for identifying humoral imbalance. Dark urine, for example, was believed to suggest an excess of "Black Bile." Once a diagnosis was reached, physicians worked to restore balance through a carefully planned treatment regiment--which included herbs, foods, and bloodletting.

Chapter II: Concerning Imbalance

A most healthy Body doeth maintain a balance of humours appropriate to its natural Complexion, but certain circumstances cause the Body umours to become imbalanced. Humoral imbalance ariseth from improper diet, travel, insomnia, slothfulness, exertion, anxiety, injury, excess, and planetary alignments. Often, many such things may skew a healthy Complexion.

A learned physician will know the following procedure for diagnosing an imbalance of the humours. First, let him discuss the imbalance with the patient to learn of changes in temperament that might have induced it. Second, the physician should examine the patientomplexion in order to perceive the proportions of humours in the body. Finally, the physician must carefully observe the colour, odor, and consistency of all excrement. Urine, feces, vomitus, puss, and discharge are the means by which the Body restoreth its natural balance, and all physicians know that they are filled with clues and excess humours. A chart can match the patientxcrement with a particular imbalance.

Treatment doeth not always prevail: The illustration at right reveals the inner portion of the brain, using perspective and shading. Intent on emphasizing his own achievement, Vesalius nowhere credited the artists who produced such works. I have heard stories of a group of doctors who did use the aforementioned procedure to diagnose a sick monk in the province of Normandy. They did find the monk to be lethargic, that his Complexion was unusually pale, and that he had superfluous mucous issuing from both his throat and lungs. The physicians did rightfully conclude that the monkondition was caused by an excess of Phlegm, which leadeth to sluggishness and appeareth in the paleness of the skin and the bodily excretions. They further surmised that the winter air of Normandy was the most probable culprit. The cool, damp air, which did flow into the lungs, infused the Vital System with an excess of cold, damp Phlegm.

Let it also be known that humoral imbalance is caused by a more complex set of circumstances than those surrounding the monkllness. The cause of the Black Death, which hath taken the life of countless souls, lieth in the alignment of Jupiter, Saturn, and Mars. The alignment draweth foul vapours into the air, which in turn upseteth the Complexion of those who breathe them. The insidious disease is so potent, it may infect entire cities.

Chapter III: Concerning Treatment

The most common treatments for humoral imbalance are the addition of opposites to the body and the removal of superfluities from it. This may be achieved by a carefully planned regime of opposing medications and foods to bring the humours back into alignment. A manurning libido can be quenched by a cool food such as lettuce. In the monkase of the previous chapter, the physicians did prescribe a dry French wine to soothe his wet, phlegmy condition. To find the appropriate medication, the learned physician knoweth to consult the most ancient volumes on herbs and medicines.

Avoiding complications most serious: Should a patient puncture his thumb or be clobbered with a mace, physicians could consult the diagram of "Wound Man," in which each letter refers to a proper treatment. Often, the application of opposites should be supplemented by the removal of superfluous humours. This can be done by the administration of herbs such as the Black Hellebore, which is known for its laxative properties, or by drawing off a portion of Sanguinous Mass through phlebotomy. When performing phlebotomy, or bloodletting as it is coarsely known, the learned physician will carefully observe the following procedure. He must first consult a phlebotomy chart to learn the proper place for drawing off the appropriate humours. Let him then place a band of cloth about the arm so that the veins distend and are apparent to him. He must then draw off the Sanguinous Mass by applying leeches to the chosen vein or he must use surgical instruments to slice it open. While making the incision, let the learned physician act with such care as to avoid severing nearby arteries and nerves, which could lead to most serious complications. The physician must also take care not to draw off so much Mass as to cause the patient to faint. Once the phlebotomy is complete, let the physician curtail the bleeding by a tourniquet or whatever other means are available.

The adjusting of diet, removal of superfluities, and consultation of both astrological charts and calendars can indeed aid a patientecovery, but the learned physician knoweth that treatment doeth not always prevail. While traveling in Genoa, I did learn of a sick nun who died in anguish while under her doctorare. Upon her deathbed, she did inform her sisters that she had Jesus in her Heart, and an autopsy revealed such marks of her devotion on the inner wall of the vital organ. Let this story remind us that no treatment can pervert the will of the Almighty.

In conclusion, let it be said that the Body be composed of four humours, that imbalance in these humours can give rise to sickness, and that a skilled physician doeth correct the imbalance using a variety of means. But ultimately the physician must remember that both decisions of life and death lieth with the Lord, whose judgment is both unerring and inevitable.

Special thanks to Christine Ruggere, and the Institute of the History of Medicine, for providing access to the images featured here. Thanks, too, to Jerome Balybyl, of the Department of the History of Science, Medicine, and Technology, whose assistance with this article was invaluable.

Return to September 2001 Table of Contents

  The Johns Hopkins Magazine | The Johns Hopkins University | 3003 North Charles Street |
Suite 100 | Baltimore, Maryland 21218 | Phone 410.516.7645 | Fax 410.516.5251