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The doctor clucked his tongue disapprovingly as he entered the room where the patient was being kept. The air was ripe with garlic and roses. The poor victim laid in the bed, their pale white flesh covered with crosses and icons. A family member stood nearby, sprinkling holy water from a small vial they'd filled at the cathedral.

"Superstitious nonsense," the doctor said with venom in his words. "You think your cousin was bitten by a vampire, so you drown him in this unscientific religious claptrap hoping to chase out the devil. Hogwash! Any thinking person with an education knows that vampirism is an affliction caused by the moist arousal of the blood. The vampire is a primordial, lustful, sanguine beast. The blood hungers for more blood, in a self-perpetuating cycle. The disease is in the blood! There's only one way to rid your cousin of this passionate infestation. Luckily for him, I brought a jar of leaches and a straight razor."

Basic Information

Humorism or Humoralism is the belief that the human body was filled with four basic substances that together determined your health and personality. The four "juices" of the body were Blood, Phlegm, Black Bile and Yellow Bile. These bodily fluids are known as the humors (also humours or cambia). Illnesses were believed to be caused by imbalances in these four traits.

Though now discredited, this system was at the heart of medicine and medical science from Ancient Greece (introduced by Hippocrates and codified by Galen of Pergamon) right up to the 19th Century. It was briefly challenged by Miasma theory in the wake of the Black Plague. Eventually both were displaced by Germ Theory and modern medical research.

According to humoural theory, you could diagnose an ailment by the personality of the afflicted. Since the classical elements were also linked into astrology, this too could play an important part in humoral medicine, with the patient's astrological profile being a key tool of the medieval physician. Other features of the body were believed to be determined by the balance or imbalance of the four humours, so skin color, shape of the head, and qualities of bodily waste would provide diagnostic clues.

Humor Internal Organ Classical Element Personality Traits Temperature & Dampness
Black Bile aka Melancholic Humour Gall Bladder Earth Melancholic Personality - Despondent, Sleepless, Irritable Cold & Dry
Blood aka Sanguine Humour Liver Air Sanguine Personality - Courage, Hope, Lust Warm & Moist
Phlegm aka Phlegmatic Humour Brain and Lungs Water Phlegmatic Personality - Calm, rational and unemotional Cold & Moist
Yellow Bile aka Choleric Humour Spleen Fire Choleric Personality - Angry, Aggressive, Ambitious Warm & Dry

Treatments involved trying to change the levels of the four humours within the body. Humoural theory allowed for different treatments to be more or less effective on various patients depending on which, how much, and specifically where in the body their humours were out of balance. (To some extent this let the doctors of the time off the hook when a treatment didn't work.)

The most famous (and one of the more colorful) methods was bloodletting, which was often prescribed if the patient had too much sanguine humour, or if their blood was deemed to be contaminated or more nebulously "bad". You might also be bled from a specific limb or vein as a cure for an excess of one of the other three humours. Those humours were believed to mix with the blood in various ratios near specific organs. It was believed blockages could result that might make it difficult for humours to properly disperse or access the correct part of the body. Sometimes bloodletting was done seasonally as a preventative measure even when the patient seemed healthy and had no symptoms.

Even if the problem was not one "best" cured by a bleeding, the treatments could still be a bit distasteful. Purges such as enemas, laxatives and induced vomiting were a distinct possibility. Elemental treatments such a cupping or even the blistering of the skin with hot irons were used to draw out or introduce the elements associated with specific humours. At it's gentlest, a doctor of humourism might prescribe dietary considerations or restrictions as every known food or drink was associated with one humour or another according to the theories of the day. (For example, a Phlegmatic individual might be told to drink more wine.)


Game and Story Use

  • Add a bit of verisimilitude to your historical or fantasy game, or just revel in the bloody awfulness of it all.
  • Magic systems seeking to feel like they fit the medieval or classical world view are as likely to call upon the humors as they are the classical elements. Here's a couple goofy ideas on D&D-style spells dressed up in hHumoural clothing:
    • I cast Greater Choleric Invocation to incite our troops with righteous fury!
    • The Curse of Phlegm will make him cold and aloof, ruin his marriage, and eventually make his brains flow out his nostrils.
  • In a game using a Our Vampires Are Different trope set, the vampires might feed exclusively on a Bile instead of Blood.
  • The middle ages equivalent of a Sherlock Holmes is likely to be well versed in humoural theory, and may use it to pigeon-hole people and anticipate their actions. "A bloody act indeed, and yet our killer is most assuredly not a Sanguine individual."
  • Humoural medicines diagnostic loopholes and inconsistent treatments might serve as cover for a quack, snake oil salesman, charlatan or con artist NPC.
    • Note that PCs will rarely fall for such gimmicks (and certainly never fall for them twice) because of the common conceit in games to give the players a clear understanding of the health levels and status of their characters. In the real world, we might be mislead by confirmation bias, placebo effect, or just a good bedside manner, but in most game systems the players will empirically know whether the goofy or dangerous medical procedure is more or less effective than the default healing rate without treatment. Expect any NPC frauds to be exposed the first time they tend the wounds or illnesses of a PC… which could be a plot point in itself.
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