Royal Anthropological Institute. Volume 2 No 4 December 1996. P741-742.

FOSTER, GEORGE M. Hippocrates' Latin American legacy: humoral medicine in the New World. xvin, 242 pp., tables, bibliogr. Langhorne, Reading: Gordon & Breach, 1994. (paper)

Hot-cold classification as a dimension of humoral (folk) medicine has been a continuing topic of interest among medical anthropologists working in Spanish America. Early twentiethcentury ethnographers were intrigued by the ways in which terms related domains of the body, health, nutrition and environment. They also were interested in what were 'indigenous' v. Hispanic aspects of Hot-Cold theory and practice. More recent ethnohistorians of medicine and philosophy have tried to trace the roots of Hot-Cold reasoning in contact-period Aztec medicine; while medical anthropologists have tried to understand how the system incorporates new information (illness ideas and material medica) and whether or not its persistence and utilization are 'adaptive' or damaging to food, health and nutrition.

This volume assembles Foster's lifelong interpretations of Hot-Cold origins and workings, based on his own ethnographic data from the Mexican town of Tzintzuntzan, and readings of other Spanish American and Old World literature. Its goal 'is to provide a comprehensive account of humoral medicine' for SpanishAmerican countries, and relate it historically and geographically to other humoral systems across the globe (p. xv). Chapter I describes humoral medicine in Gracco-Persian-Arab, Ayruveda and Chinese traditional medicine, and attempts to trace their legacies in Spanish America. He contrasts the Old World humoral systems, where medicinal aspects formed parts of more general philosophical systems, to HotCold as a more restricted theory of humoral medicine in the New World.

Chapters 2, 3, and 4 describe in detail humoral medicine in Tzitzuntzan, Mexico, and compare principles and operations with that of other Spanish-American and Old World systems. Variations are analysed also as part of chapter 5, which probes the question of classification how values are ascribed to medicines, body states and other domains. An appendix lists 287 hot-cold items and levels of 'agreement' among 10-33 respondents on the Hot-Cold classification of 287 items. Chapter 6 examines the significance of the 'neutral' category as a way to incorporate new food and nutritional information and maintain healthy dietary balance.

Chapter 7 argues that Hot-Cold is used primarily to validate (post-facto) rather than to guide curing behaviours. This interpretation helps explain why some anthropologists working in Mexico insist that Hot-Cold is not the most significant curing category; it often is referred to at the end rather than at the beginning of the curing sequence. However, this interpretation ignores preventive illness behaviours; i.e. women carefully add Hot elements to Cold foods so that they will not cause harm to a child's body known to be in a predominantly Cold state. It also ignores the way in which Hot-Cold labels themselves serve as guides for what empirical medicines to administer. Any traditional corpus of herbal medicine contains multiple remedies for headache, body ache, diarrhoea, etc. Herbs are used on the basis of perceived effectiveness for a given ailment, such as cough, but herbs are also selected according to other qualities, including Hot-Cold, as people seek to match the appropriate remedies to symptoms. They may work back and forth to arrive at a post-hoc diagnosis and explanation for why one herb rather than another 'worked', but Hot-Cold is one dimension of a priori guide as well as post-facto rationale in the curing process. Particularly in the preparation of 'compound remedies, which usually contain a number of Hot and Cold elements to treat a syndrome of unknown origin, mixing Hot-Cold elements is a way to hedge one's bets while keeping the Hot-Cold principle and qualities of materia medica in mind right from the beginning. On the basis of his interpretation of the Tzintzuntzan data, Foster dismisses the possibility that certain Hot-Cold information is already 'chunked' into a remedy; and also the likelihood that with attrition, dimensions of more systematic Hot-Cold thinking may have atrophied into sets of empirical knowledge devoid of theory

The theoretical v. empirical knowledge debate is significant, because it enters into the following chapters' discussions of New v. Old World origins. In the face of new data, Foster continues to argue for an Old World origin (hence the title of the volume), and presents acceptable and convincing evidence for Old World influence; and introductions in the forms of ideas, illnesses (and illness classifications), and materia medica. Contra Foster, one could argue that by now there have been more than 500 years for New World cultures to develop syncretistic systems, and ample time for elite medical ideas from multiple cultures and periods to percolate down to popular village practice. Contemporary indigenous medical systems tend to draw on multiple medical traditions. Mexican indigenous Hot-Cold lexical draw on multiple distinct concepts and words for heat and cold that are absent in Spanish or English, and represent significant syncretisms and local interpretations of what also may have been Spanish categories. Foster accepts the argument that Hot-Cold was an element of a binary world view among indigenous Spanish American cultures, but he remains reluctant to admit that this is relevant to the interpretation that New World medical systems with HotCold dimensions draw on indigenous elements. Even though he can show that Hispanic humoral medicine was foreign to indigenous medical thinking, and that it then influenced and penetrated local practice, this line of derivation from Hispanic sources does not falsify a claim that humoral medicine syncretized with local practices based on a binary world view. In brief the argumentation and evidence does not convincingly negate the possibility of multiple autochthonous New World along with Old World origins.

These chapters rely on data and arguments drawn from Foster's previously published ethnography and articles. A short concluding chapter is 'reflexive', in that Foster draws on his own personal experience to describe U.S. folk analogues to his experience of the Tzintzuntzan Hot-Cold categories. An epilogue briefly discusses issues of adaptiveness and implications for the future. Foster concludes that the theory per se is not, although particular practices, such as balancing Cold water with Hot salt (because it repletes electrolytes in cases of dehydration) may be beneficial. He also accepts the interpretation that overall, humoral medicine may be of some psychological value where it is widely endorsed, as in Asian cultures. Foster also finds that humoral medicine is disappearing, specific dietary rationales in Hot-Cold terms will remain only so long as perceived to be useful; most curing information is already gone in the younger generation. Unfortunately, he does not discuss what aspects of the system he predicts might endure or why; or under what circumstances people might retain Hot-Cold as a way to organize the world. What else does a culture lose besides its ethnomedicine as such ordering principles decline? He might have devoted more attention to the issue of how knowledge is structured and how it changes not only in the face of new nutritional and health information and non-local foods and materia medica, but also possible pressures to preserve 'indigenous' knowledge and culture and ethnobiology.

Overall, the volume is a well-organized review of Foster's thoughts on Hot-Cold, presented in a very readable fashion. For those with no background on the issues, it constitutes a good introduction. Those with such a background will want to use this most recent compendium to help refute his two conclusions: no New World origins and Hot-Cold as strictly humoral medicine, divorced from cosmological system or theory in New World contexts.

ELLEN MESSER

Brown University

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