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A Good Sense of Humors: The Humorous and Humoral Treatments of David Barnes

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A Good Sense of Humors: The Humorous and Humoral Treatments of David Barnes

Written, edited, and photographed by Naomi Shavin.

“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.

    • hummedp9303480web
    • Students in Medicine in History research humoral medicine in Van Pelt Library's Kislak Center for Special Collections, Rare Books and Manuscripts.

College senior Alyssa Bonnell shared some of the surprises of her diagnosis.

“Before this assignment, I had never considered what time of year I typically get sick and what factors in the environment disturb my humoral [...] balance.”

What is Alyssa’s natural humoral balance? She actually found that her humoral constitution was changing.

“I learned that as a person transitions from […] infancy to childhood and childhood to adulthood his or her humors may slowly change. And that's what I found was happening to me.”

Alyssa related her changing humors to her awareness that she is about to graduate college and start to “be a real person.”

“When I came back to school this year, I became anxious and I was really, you know, irritable. I even had some trouble sleeping, which isn’t like me,” she explained. “I don’t consider myself to be a sad person, but I read that an individual with a melancholic temperament is typically irritable, anxious and unable to sleep and I knew, ‘Yep, that’s me!’ I ultimately diagnosed myself as an patient transitioning from a young sanguine temperament to an old melancholic one, with lots of surging black bile.” Alyssa punctuated her assessment with a laugh and her assessment surprised me, too, but we didn’t question the diagnosis. Humoral medicine may factor in external behaviors and influences, but ultimately, it assesses what is changing inside each of us.

Another senior in the class, Jeremy Pincus, came to the project with an advantage. Jeremy works in the Rare Books library. His biggest take away didn’t come from the books, but rather from his own symptoms diary.

“I noticed that I feel a lot of different things over the course of the day — meaning that when I was jotting down my moods, symptoms, I was visually reminded of how I felt earlier in the day. So many of those emotions and sentiments are fleeting and it was interesting to constantly relive the highs and lows of my week.”

A good humoral physician might be concerned that Jeremy is so emotionally full, he is bordering on plethora. Jeremy figured the same.

“To be honest, the TAs [...] told me that the symptoms weren't characteristic of plethora. Oh well, at least I tried hard.” That attitude may seem sanguine, characteristic of a happy-go-lucky person with an excess of blood. Perhaps Jeremy’s TA’s, however, perceived his rationality and propensity for calm acceptance and pinpointed him as phlegmatic, a diagnosis that could have explained why Jeremy developed bronchitis a few weeks after his symptom diary was complete.

    • History of Medicine students
    • Left: Alyssa Bonnell, Health and Societies major, C'14.
      Right: Jeremy Pincus, History and Sociology of Science major, C'14.

Dr. Barnes has a story about a student whose humoral diagnosis was eerily predictive.

“A student, when she took my course, she had been having stomach problems, or gastrointestinal issues, or stomach pain, various sort of non-specific symptoms that had continued over time.” According to Dr. Barnes’ email exchanges with the student, her symptoms proved mysterious when the MRI that her physician recommended found nothing amiss. When she did the humoral medicine assignment, she ended up diagnosing herself with an excess of yellow bile. Following the assignment, her symptoms fluctuated, sometimes disappearing, other times returning with full force until, eventually, she decided to seek additional medical council. “She went to another doctor who did more tests, and eventually diagnosed a problem with her gallbladder,” Dr. Barnes recalled. “She eventually had her gallbladder removed and her symptoms disappeared. She was completely better. And so basically, the assignment had correctly diagnosed a disorder, a bile disorder, like a biliary dysfunction, and although it did not cause her to prescribe gallbladder removal, it was surprisingly on target.”

He shared the story with the class, but went into greater detail when he repeated it, at my request, in his office, a space that seems like a direct manifestation of his personality. The rectangular room has a large window that faces into campus and frames several trees. Almost every surface area is in use. Papers, files, folders and books take up most of the space, but medical cartoons and stuffed animal interpretations of familiar bacteria and viruses have their places, too. Hanging maps of France reflect a commonality between the two books he’s written. His first is called The Making of Social Disease: Tuberculosis in Nineteenth-Century France. The second is titled The Great Stink of Paris and the Nineteenth-Century struggle against Filth and Germs. On the topic of his second book, Dr. Barnes explained, “I tried to show how the scientific agenda was shaped by cultural concerns [...] and political concerns and how the social and political concerns were fed and reshaped by the science.”

    • David Barnes
    • Dr. Barnes in his office in Claudia Cohen Hall.

The cross pollination of ideas that he described reminded of me a maxim I once heard about the chemistry of a successful novel — that it has to be a psychological story, but that it also has to concern itself with greater issues at least to a small degree, such that it could be said that every great novel is, to some extent, political. I asked Dr. Barnes if he views his approach to teaching history as novelistic, specifically in the case of the humoral medicine assignment, in which each student in the course is supplied with two protagonists with whom they can deeply identify — themselves twice over in one narrative, caught in a Dante-pilgrim/Dante-poet model. Here they are both Dante-patient and Dante-physician.

“Over the years, I have become more interested in using storytelling in my teaching and in my research,” Dr. Barnes admitted. He went on to identify two goals that he has for his third book, currently in progress, on Philadelphia’s Lazaretto quarantine station, and it sounded like they could be goals that he hopes each of his students have in their writing, too.

“I want the scholarship to be impeccable but I also want to be a storyteller, to use stories to show how and why this place is important and why the history it represents is important.”

True to his word, stories and personal narratives weave through every major topic in Dr. Barnes’ Medicine in History course, not only the humoral medicine assignment. His sense of humor is ever-present, too. He’s got an improv shtick in which he imagines how a debate on cleanliness involving Florence Nightingale and Joseph Lister might play out — but that’s another story.


Naomi Shavin is a senior from Atlanta, Georgia. She is majoring in English with a concentration in creative writing and minor in journalistic writing. She is an editor for Penn Art & Culture and an editorial assistant for the academic journal Jacket2.