“There’s blood drives all the time,” David Barnes assured me. “In fact, even when there’s not a blood drive, HUP [the Hospital of the University of Pennsylvania] has a blood donation center that’s basically open everyday.”
We were in Dr. Barnes’ office on the third floor of Claudia Cohen Hall, discussing a suggestion he made early in the semester, delivered in deadpan, that students in need of a bloodletting visit a blood drive, where they should give an emphatic explanation of their need for lightness and their concerns about plethora. In the medical tradition, beginning with the ancient Greeks and arguably still represented in cultural trends like juice cleanses and diets that incorporate fasting, plethora is the condition of being too full. A person can be physically too full, spiritually too full or emotionally too full, and for centuries, fullness and heaviness of any kind were seen as a serious medical condition that any knowledgeable physician would treat with bloodletting.
When Dr. Barnes first suggested that students request a bloodletting at a blood drive, his 80-student Medicine in History lecture had a good laugh. Students in Dr. Barnes’ class are used to his sense of humor, his theatrical commitment to acting out the attitudes of the individuals he describes, and his knack for finding classic rock songs that capture the sentiment of a particular medical moment in history, like Talking Heads’ “Once in a Lifetime,” or “Air” or Sex Pistols’ “God Save the Queen.”
If Dr. Barnes’ sense of humor came as a surprise to any of his students, it couldn’t have been as surprising as the first assignment in his course. In line with the course’s stated objective, to examine medical history from the inside out, essentially to understand it by empathizing with the experience of it, Dr. Barnes created the humoral medicine assignment.
The assignment has two parts. The first part is to keep a symptom diary that records anything that would have been of interest or of relevance to a practicing humoral physician. The main tenant of humoral medicine, the system of understanding health and the human body that dominated most of recorded western medical history for centuries, predating Christianity and influencing doctors up to the eve of the American Revolution, is the idea that the body is composed of four humors: phlegm, blood, yellow bile, and black bile.
The system is more complicated than that, though. Each humor is associated with a season, with an element, with a temperament, and with a quality of dryness or wetness and cold or heat. For instance, an individual with an excess of black bile would find him or herself to be melancholic, to be cold and dry, and to relate to the earth and to autumn. They might find themselves to be more melancholic than usual during autumn, or when on a diet of cold, dry foods, because these circumstances would exacerbate their tendency toward excess black bile. Cold, dry weather could be dangerous to that person’s humoral balance, and a physician might actually recommend that a melancholic person move to a wetter, warmer climate to balance out his or her internal constitution. Another critical component of the system is the six non-naturals: environment, food and drink, evacuations, exercise, rest and wakefulness, and emotions. These aspects of daily existence were seen as within a patient’s control or influence, to a certain degree, and proper integration of the six non-naturals were, and still are, essential to maintaining health.
And so Dr. Barnes’ students each spent a week recording the qualities of the foods they ate, the hours they slept, the way the wind blew, how their day made them feel, how long they spent at the gym, whether they noticed anything strange in their bodily functions, and which activities they scheduled for themselves.
When a weeklong symptom diary was complete, students moved to the second part of the assignment: diagnosis. Pretending to be a 17th century physician, each student visited the rare books collection in Van Pelt Library to research humoral diagnoses and remedies. Armed, perhaps paradoxically, with iPhones, laptops, and hi-resolution digital cameras for copying and capturing helpful texts, the students aimed to get inside the mind of a humoral physician in order to successfully diagnose their own conditions. If Barnes’ sense of humor and the design of this assignment didn’t faze his students, then certainly their own diagnoses did.