Humoral/Environmental Ideas in Medicine

Each of hundreds of schools of medical thinkers contributed its own version of the medical meanings of humoral/environmental ideas. This multiplicity of uses is a sure indication of the fruitfulness and importance of these theories.

Galen’s development the humoral/environmental tradition embodied in the Hippocratic corpus, with the inclusion of Aristotelian and Stoic elements, gave rise to a complex medical system complete with an elaborate pharmacology. During the Middle Ages the humoral/environmental tradition persisted through the Arabic renderings of the original ideas. The so-called Arabized Galenism of Avicenna is a case in point.

With the Renaissance return to the original Hippocratic and Galenic texts, the stage was set for a long polemic. The filtering of humoral/environmental ideas into Western folk medicine, the variety of medical traditions derived from Arabized Galenism, and the ferment created by the reading of the original texts set the medical world in motion. The competing schools based their ideas essentially on different readings of the same basic texts. When Arabized Galenism is compared with the Galenism inspired by a direct reading of Galen’s texts, it appears to be a completely different, radically opposed school of medical thought and practice. Hippocratics, Galenists of all kinds, “physicians,” “chemists,” and herbalists flourished and did battle. Yet despite this ferment, the pace of change in the medical schools was slow. Most medical schools persisted in complex, philosophically abstract medical theorizing long after real alternatives had been suggested.

These developments set the stage for the Enlightenment attack on institutionalized medical thought and practice. Enlightenment thinkers familiar with the classical texts were persuaded that medical knowledge and practice had to be concrete, empirical, and individualized. The purpose of medicine was to understand an illness and to collaborate with the inherently harmonious forces of nature in getting the patient well. For these thinkers, the abstract philosophical training that doctors received and the regular medical use of strong drugs and bleedings were major causes of death.

The tendency of historians and philosophers to overlook the immense social and intellectual influence of physicians was noted earlier in regard to Hippocrates. Physicians, certainly by the time of the Enlightenment, were viewed as scientists and professionals, and their social and political views carried great weight. Long before Darwin, scientists were considered important social thinkers.¹

The Life and Works of Torres Villarroel

Diego de Torres Villarroel, born in Salamanca in 1694, was professor of mathematics at the University of Salamanca. But he was more than a professor: he was a qualified medical doctor, a priest, natural scientist, poet, dramatist, essayist, the most famous Spanish astrologer of his time, dance instructor for a brief period, administrator of some of the Duke of Alba’s property, and philanthropist.

Torres was an unabashed admirer of his famous literary predecessor Francisco de Quevedo; many of his literary works are attempts to mimic the works of the great seventeenth-century Spaniard. Yet with a few erudite exceptions, Torres’ works are largely forgotten. His overpowering satirical style and continual sermonizing make his fifteen-volume complete works less than easy to read. Only two of his works have remained in print since they were published. Since 1977, two more have been reprinted.² This fate seems partly deserved, but literary criteria of evaluation have seriously obscured the larger historical lessons to be learned from Torres’ more scientific work.³

This immense and heterogeneous corpus is a rich lode for the anthropologist and historian of science. It articulates a coherent vision of the world, society, and the human condition in which cosmology, theology, ethics, natural science, medicine, and social criticism are linked. Of particular interest is a strong current of social criticism based on a kind of moral egalitarianism. And in all these dimensions humoral/environmental ideas play a critical role.⁴

Torres’ father was a bookbinder. Though the elder Torres was well respected in Salamanca and ultimately served the city in important administrative posts, these are most modest beginnings for someone who was to become a university professor (as Torres never tired of reminding his readers). In 1715 Torres took the first formal step toward becoming a priest, but he did not seek ordination until thirty years later. Torres’ literary career began in 1718 with the publication of his first astrological almanac. He published one a year until 1753, earning much fame and money, a fact he liked to point out from time to time.

The year 1718 marked his first visit to Madrid, where he was eventually to reside for some years. There he engaged in medical studies and made powerful friends among the nobles. He completed his medical studies but determined never to practice medicine, a promise he broke only a few times, under the pressure of poverty. In 1726 Torres acquitted himself well in the competitive public examinations to fill the chair of mathematics at the University of Salamanca, but he had to wait eight years until the death of the previous incumbent freed the funds to permit him to fill the post.

Torres was involved in more than his share of conflicts. By his own admission, he was a rascal. In 1732 he was exiled to Portugal for his participation in an event that has not been clarified in his autobiography or by any of his biographers. But he returned in time to fill the chair of mathematics in 1734. Though he evidently was a good teacher, he was a trying colleague. Always conscious of his social origins, he saw himself as an intrusive foreign body in the university. He never tired of attacking the pomposity of the other professors. The university records show that Torres was often absent in Madrid, a point his enemies endeavored to use against him. But the records also show that Torres was regularly entrusted with complex, important duties by his colleagues, duties that required the mobilization of his contacts in Madrid.

In 1745 he finally determined to be ordained as a priest. This decision was accompanied by a severe illness, a point that has given psychologically oriented biographers much to speculate about.

He retired from his professorship in 1751 but remained active in university affairs practically till his death, in 1770. During his retirement Torres saw to the publication of his complete works, an effort amply supported by an impressive list of subscribers. He also became an active supporter of charitable institutions in Salamanca and a member of the household of the Duke of Alba.

Torres’ corpus can be divided into three clear categories: cosmology-astronomy-astrology, natural science, and medical/moral works. A large fourth category consists of miscellany. The cosmological-astronomical-astrological works are diverse. From the physical structure of the universe to almanacs and star charts, Torres covered a wide array of subjects. The almanacs contain attempts at weather prediction with frivolous (according to Torres himself) predictions of events. But he sincerely believed in the influence of astral bodies on the earth and on the physical condition of living things, and constructed astral tables for public use.

His natural science interests were also diverse, covering such topics as beekeeping, geology, the causes of earthquakes, the sources and uses of mineral waters, and why a rooster transported across European time zones crows at a particular hour. These works convey great enthusiasm for empirical science and a desire to communicate the findings of natural science to the general public.

Torres’ medical/moral works combine medical manuals written for the lay public, literary works with a powerful emphasis on health, and extraordinarily harsh criticisms of medical education and practice.

The miscellaneous works form a bewildering array. Among them is Torres’ well-known autobiography, published between 1743 and 1758. In it he justified himself, poked fun at his own foibles, and evened many old scores. He also wrote lives of saints, plays, poems, and even an essay on bullfighting.

Cosmology and Natural Science

For Torres, natural science’s empirical, inductive methods served to disprove many ancient commonplaces and measurably to improve the general quality of life. This part of Torres’ corpus is enormous. These works rest on a consistent cosmology in which the structure of the cosmos, astronomy/astrology, and natural science are tightly interwoven. For Torres a theory of the material structure and operation of the cosmos was the necessary context for astronomy/astrology and by extension for the study of natural phenomena on earth, such as earthquakes, the humors, and the habits of bees and roosters. Thus to be understood, his humoral/environmental theories must be placed within this larger context.

In Cartilla rústica (Rustic note) Torres portrayed himself as the teacher of a peasant who was to use his new knowledge to improve the quality of life in his home village. To begin the instruction, Torres diagrammed the cosmos as a set of twelve concentric spheres with the earth in the center.

Through this conventional image, Torres explained that the cosmos is orderly, hierarchical, and totally permeated by the four elements. The entire system is perfectly balanced.

This general vision was associated also with the complementary view of the macrocosm and the microcosm. In his Anatomía de todo lo visible e invisible (Anatomy of all things visible and invisible) Torres took some companions on a fantastic voyage to the center of the earth.

In this way Torres asserted that from the macrocosm to the microcosm, the material basis of all things and the operating principles are always the same.

El hermitaño y Torres (The hermit and Torres) elaborates this notion. The entire system is a harmonious whole in which the four elements play a principal role.

This idea was further developed in Cartilla astrológica y médica (Astrological and medical note) (1794—99, vol. 6). After setting the cosmological context for humans, Torres presented the “four natural virtues”: generative, vital, animal, and natural. The generative virtue is under the influence of Venus, the vital under the control of the sun. Animal virtue is not associated with a particular astral body here. Rather it is divided into two realms, each associated with particular primary qualities of matter. The two realms are the cognitive and the sensual.

The cognitive realm is divided into imagination (hot and moist), fantasy (cold and moist), knowledge (hot and dry), and memory (cold and dry). In the realm of the senses, sight is associated with cold and moist, hearing with cold and dry, taste with hot and moist, smell with hot and dry, and touch with a mixture of all four qualities.

Natural virtue, now as one of the four natural virtues, is divided into the four humors, each under a particular astral influence: blood (Jupiter), phlegm (the moon), choler (Mars), and melancholy (Saturn). The possibilities for metaphorical combination and opposition in such a system are immense. At the same time the macrocosm/microcosm link is pressed to its limit.

Torres’ system contains nothing unique or new. He was a firm believer in humoral/environmental theories, and they formed the basis of his cosmology, natural science, medicine, and even theology (in part). These beliefs explain his interest in astronomy/astrology (Torres did not differentiate the two clearly). Within the structure of his cosmology and the universal operation of humoral/environmental principles, astral influences are a logical necessity. If the universe is a set of twelve circles with the earth at the center and if the material principles of all processes are the same, then logically movement in any one of the twelve spheres will influence the others, and the larger (outer) spheres will more strongly influence the smaller (inner) ones. Thus Torres believed in astral influences as a matter of scientific faith.

The Human Condition: Theological/Moral Populism

Humans, as both material and spiritual beings, must live at once in two realms that are difficult to reconcile. In Torres’ view, the spiritual realm is the more inclusive; the body is a momentary part of the soul. The body, as part of the soul, necessarily must be respected, and this respect must take the form of treatment in accord with the general material principles of the universe. The punishment for failure to respect the body is physical torment and death; for failure to respect the soul, moral anguish and eternal damnation. Failure to respect the body is an important step toward eternal death.⁶ Yet even the most judicious attention to the body cannot protect it from death. “My whole body is a portable infirmary of humors. I am sick. And ruined by nature. I am sick. That is why I have laughed at medicine for being so foolish as to presume to give health to mortal man” (Torres Villarroel 1794–99, 3:34).

Individuals have different humoral constitutions, react differently to material forces, and have different strengths and weaknesses. Care of the body must always be empirically adjusted to the constitution of the individual.

Torres insists throughout his works that illness is no respecter of social class. He treats illness as a portentous reminder of the fleetingness of moral life and its honors. Illness highlights the need to attend to the soul’s business. Indeed, Torres often seems to feel that wealth is great danger, because the rich face more temptations and can afford more vices. Occasionally he romanticizes the simple life of the countryman, who passes his life in hard work and simple pleasures.

Torres’ social criticism must not be overestimated. His egalitarianism derived necessarily from his belief that all humans are equal before God, not from a desire to promote social revolution in this world. Still his egalitarianism and social criticism, combined with the repeated references to his own humble origins, at least place him in the intellectual tradition that flowered in the great democratic revolutions.

The work that best stands as a summary of Torres’ view of the human condition is Vida natural y católica (Natural and Catholic life.)⁷ Consonant with his ideas, the book was written as a self-help manual for the general public. The first of its two major sections deals with “natural”—that is, physical—health. Torres describes in great detail hygienic and dietary practices designed to maintain bodily harmony. Here humoral/environmental theory is the key element as he passes from diet, exercise, sleep, and excretion to mental health. General precepts are given, but always with the caveat that they must be adjusted to the constitution of each individual. In the second part of the work Torres takes up the precepts to be followed to maintain spiritual health.

Perhaps the strangest and most interesting work of all is Los desahuciados del mundo y de la gloria (Those evicted from the world and from glory). Torres is taken by a devil on three journeys to witness the agony, physical death, and damnation of a variety of people. Both sexes, various social classes, and various diseases are represented with astonishing clarity. In each case the clinical side of physical illness and death is presented in excruciating medical detail. Indeed, this apparently disproportionate interest in physical illness clearly spoils the work for many literary audiences. But this detail is integral to Torres’ thought about humanity as a “portable infirmary.” The multitude of ways in which illness can attack and the helplessness of medicine must serve to persuade the audience that the only final salvation is spiritual.

Following the clinical portrait of each illness is an equally clinical portrait of the causes of the individual’s spiritual damnation. All of the patients are damned, and the portraits of the demonic hosts mimic those of Dante. It appears that the physical neglect that led to illness was a symptom of a deeper spiritual neglect. Thus the message of the two parts of Vida natural y católica is repeated. Torres was pitiless and repetitious in his condemnation of degradation of the body and of the soul.

The remedies for these ills are within the reach of all people, rich and poor alike. The rich are particularly blamed for their behavior because they have the resources to live correctly and often do not. The poor can be excused in part for their ignorance, as few writers have directed their attention to humble audiences. Torres’ desire to communicate these lessons to the humble is an indication of his moral populism. This attitude becomes most pronounced in his criticisms of medicine.

Critique of Medicine

Torres’ attitudes toward medicine were rooted in his humoral/environmental ideas, his profound belief in empirical science, and his populism. No specific element of his critique is uniquely his own. His particular criticisms of medicine and his theoretical points of departure were widely shared, as the writing of Martin Martínez (1748) and Benito Jerónimo de Feijóo (1724–39) attest. What makes Torres’ views interesting is his combination of widely shared criticisms of medical education and practice with a consistent attempt to create a “naturalistic” medicine “for the people.” Within the total corpus we find an immense array of scathing denunciations of medicine.

A major emphasis in Torres’ critique was the weak empirical foundation of medicine. He felt that medical education emphasized philosophical abstraction at the expense of empirical research. The scientific pretensions of the medicine of his time thus were to him intolerable pomposities and genuine physical dangers. He counseled good diet and living habits as the best, and certainly the safest, medicine.

Torres portrayed doctors as a dangerous luxury that only wealthy societies could afford.

The doctor does not cure, he merely witnesses the course of the disease and charges for his observation. And doctors have clients because of the cowardice of people faced with pain and death.

Torres’ criticism goes further. Doctors are even active agents of illness.

Torres firmly believed in medical self-help and in the obligation to care for oneself, physically and spiritually. No one can know us as well as we know ourselves; the expertise of doctors is a fraud.

Torres’ critique of institutional medicine was partly designed to convince ordinary people of their ability and duty to fend for themselves. Not only was institutional medicine bad, but what little knowledge there was did not find its way to the people; it was hoarded as a lucrative medical monopoly. Vida natural y católica, Recetas de Torres (Torres’ prescriptions), Médico para el bolsillo (Pocket medical handbook), and the various Cartillas (Notes) were all written as medical guides for the general public. This popularizing intention is proudly stated in each work. All are written in Spanish rather than Latin, and the language is reasonably simple and direct. Torres believed that people could be their own scientists, their own doctors, because the relevant knowledge was directly available through empirical observation and simple induction. Empiricism and populism were thus linked.

Torres believed that popular medicine would necessarily have certain characteristics, derived from humoral/enviromental theory. Such medicine would be based on nonradical, nonintrusive treatments that supported the “natural harmony” of the body. Diet, environmental change, exercise, rest, and meditation were the keys. Many of Torres’ ideas could pass muster among contemporary holistic and naturalistic practioners.

Occasionally Torres, like many contemporary believers in naturalistic medicine, flirted with the idea that most serious medical problems were caused by the “unnatural” way civilized people live.

Although Torres approached popular medicine from many angles, his works on the uses of mineral waters provide the best overall synthesis of his medical ideas. Two monographs on three mineral springs in the province of Salamanca link his cosmology, geology, natural science, and social criticism into a general humoral/environmental vision of the human condition. The first monograph, published in 1744, is titled Usos y provechos de las aguas de Tamames y Baños de Ledesma (Uses and benefits of the waters of Tamames and baths of Ledesma). Though Tamames has been abandoned, Ledesma is now the home of one of the largest and most modern spas in Spain. Torres dedicates the monograph to the owner of the lands where the springs are located. This dedication evokes most of his humoral/environmental vision.

After detailing the properties of the waters, Torres asserts the reasons for their curative powers: “Water, in my understanding, is nothing less than a liquid powerfully suffused with the virtues of the stars, airs, metals, branches, seeds, animals, and all things visible and imaginable in the lower and higher realms of the world” (4:237).

Each person must be treated individually because people’s constitutions differ, and the treatments must be explained in language intelligible to the ordinary patient.

He strongly criticized the doctors of the University of Salamanca for not having made the public aware of these waters and their uses.

In 1753 Torres wrote again on mineral waters, in Noticias de las virtudes medicinales en la Fuente del Caño de la Villa de Babilafuente (News of the medicinal virtues in the Fountain of the Spring of the Village of Babilafuente). This spring is still in use. Here the same general themes are repeated, and the criticism of organized medicine is even sharper. In a prologue addressed sarcastically to the “Deceased Doctors of the Medical Schools of Spain” he denounces the stupidity and even criminality of systematic medical ignorance of the uses of mineral waters, especially in view of a standing request by the Royal Practical-Medical Council for such information.

These virtually unknown essays on mineral waters clearly reveal the structure of the thought of this Enlightenment humoralist. The material cosmos created by god; the geology of the earth giving rise to airs, waters, and places; the humoral conditions of human life; and the battle against socially oppressive and morally inexcusable manipulations of knowledge are linked in a single, consistent pattern of thought.

Conclusion

This excursion into the works of Diego de Torres Villarroel provides a broad sense of the symmetry and interpretive scope of humoral/environmental theories. Torres’ entire system is characterized by consistency and balance. Still Torres’ system of thought is clearly nonevolutionary, in the same way as is the system used to explain and justify the preeminence of the nobility. In his view the natural world was created once and for all by God and has not changed significantly since then. His faith that empirical investigation would yield useful results is based on a belief that the Creator is beneficent and that his creation is formed of clearly defined, stable classes of things. The natural order is a moral order by definition.

Torres’ thought is also characterized by tension between genealogical and environmental principles. He clearly believes that a great deal can be accomplished by manipulation of the environment, and in that sense he differs greatly from earlier Spanish apologists for the social order. His approach to popular medicine is informed by a belief that sensible diet and lifestyle can greatly improve health. That is, he believes environmental manipulation can have important effects on health. His critique of medicine also implies that people who permit themselves to become overintellectualized (as the academic physicians had done) can lose touch with the principles at work in the world. Poor training could only have the power to create poor doctors if the environmental principle were a potent force.

Together two very different deployments of humoral/environmental theories show that these views have a very broad scope. Humoral/environmental theories are complex, flexible, and diverse—and they also have a pleasing overall integration. At the extremes, they have given rise to arid abstract scholasticism and mindless empiricism. They still hold astonishing power in the Western world, as the currency of some of the concepts used to justify nobility in current racist ideologies and the apparent similarity of Torres Villarroel’s medical views to those of contemporary holistic medical reformers both suggest.

One of the most powerful characteristics of humoral/environmental ideas, seen in all the literatures discussed, is that they are constructed to make moral and political decisions seem empirical. These views consistently argue that the social structure or human behavior must follow a certain pattern because “nature” or “human nature” requires it to do so. The connection between analysis of the “natural” world and political and ethical conduct is made to appear direct and scientific.

In order to make this argument appear plausible, it is necessary that the natural world be both static and coherent. The humoral/environmental world is one of fixed categories, of constitutions that tend toward harmony. The categories were created once and for all in the beginning and they cannot change. The “marvelous machine” runs on forever. Indeed, the problem of change in categories appears in the persistent conflict between the genealogical and environmental principles in these theories.

When Darwin succeeded in synthesizing the actions of the environmental and genealogical principles and showed that the continuing origin of species (natural categories) was an inescapable theoretical and empirical conclusion, he demolished the very foundation of humoral/environmental theories. With them also was demolished the apparently easy and obvious connection between natural categories and moral rules. The blow was so sharp and so surgically delivered that many of its implications have yet to be assimilated.

To a surprising extent, the static vision of the world on which the humoral/environmental scheme depended marches on, though it is maintained only at the cost of serious contradictions. Nor is it carried forward only by some fringe group of antiscientific thinkers. Many pre- and nonevolutionary ideas persist in the theoretical and empirical works of major contemporary scholars who consider themselves to be in the forefront of applications of evolutionary principles to the analysis of human behavior. The extent to which nonevolutionary elements invade the work of these scholars will, I hope, show clearly how much remains to be done before the Darwinian revolution can be considered complete.