Hippocrates' Latin American Legacy: Humoral Medicine in the New World. By George McClelland Foster. Langhorne, Penn.: Gordon and Breach, 1994. Pp. xvii + 242. Theory and Practice in Medical Anthropology and International Health, Vol. 1. $40.00 (cloth). ISBN 2881246109 (cloth); ISBN 2881246117 (paper).
Hippocrates' Latin American Legacy comprises 10 chapters plus a short introduction and epilogue, an appendix, an extensive bibliography, and a useful index. Chapter I states the general problem. Chapters 2, 3, and 4 deal with humoral theory in Tzintzuntzan, Michoacan (its basic principles, disease causality, and therapy). Chapters 5, 6, and 7 clarify issues concerning the ascription of humoral values, the neutral value in humeral medical systems, and the validating role of humoral theory in therapy. Chapters 8 and 9 deal with the diffusion of humoral medicine to many parts of the world, and Chapter 10 discusses humoral elements in American popular medicine. I have selected for discussion those issues that are potentially of the greatest interest to Nahua scholars.
In Chapter 1, Foster discusses the three world variants of humoral medicine: the Ayurvedic of India, the Chinese, and the Hippocratic-Galenic or Graeco-Persian-Arab humoral traditions. The author's clear presentation of the basic pattern of humoral medicine in the Americas is commendable.
Briefly, foods, remedies and many other substances have a metaphoric quality--a humoral value of "Hot," "Cold" or "Temperate" that is distinct from their thermal temperature. Illnesses are explained "as due to hot and cold insults (sometimes thermal, sometimes metaphoric) that upset the bodily temperature equilibrium that is believed to spell health. A hot insult produces a hot illness, while a cold insult produces a cold illness. Therapies... conform to what has been known since the time of Hippocrates as the 'principle of opposites': a Cold remedy for a hot illness and a Hot remedy for a cold illness" (p. 3).
Foster capitalizes the first letter of words for humoral values (Hot, Cold, Temperate) and uses lower-case initial letters for thermal temperature values (hot, cold, temperate). All scholars should consider adopting this potential standardization since it would eliminate a considerable amount of confusion that currently exists in discussions of humoral medicine.
A second strength of this chapter is his overview of the diffusion of Greek humoral medicine, which "under the Moslems, [diffused] eastward through Iran, Afghanistan, Pakistan, India, Bangladesh, Malaysia and parts of Indonesia, and westward to Europe, Latin America, and the Philippines" (p. 12). This diffusion of Greek humoral medicine is followed up in detail in Chapters 8 and 9.
Chapters 2, 3, and 4 specifically discuss humoral theory in Tzintzuntzan. It is evident that Foster is a very skilled field worker. For example, he observes that metaphoric/humoral values in Tzintzuntzan apply only to material items and that, with rare exceptions, humoral values do not change (p. 26). He is a keen observer and a very careful listener, perhaps the most important attributes of an ethnographer.
Foster arrives at generalizations through induction; two are of particular interest. First, "[I]n Tzintzuntzan thermal temperature is cited far more frequently as the precipitating factor leading to illness than is the humoral value of food or drink. With respect to therapy, the opposite is true: thermal temperatures of remedies are far less important than are their humoral calidades" (p. 41).
Second, "Turning to etiologies, the most remarkable thing about illness causality concepts in Tzintzuntzan is that almost all illness is attributed to natural causes, and not to supernatural or magical sources. This characteristic, of course, marks humoral medical systems in general, and it stands in striking contrast to the etiological beliefs found in tropical South America, indigenous North America, Africa, paleoarctic Siberia, and Oceania, where witchcraft, soul loss, object intrusion, possession, breach of taboo, and the ghosts of ancestors are the most frequently named causes of illness.... [Unlike these personalistic medical systems], in Tzintzuntzan, people (insofar as illness is concerned) are far more concerned with their relationships to their natural environment than to their neighbors" (pp. 69-70).
Chapters 4 and 7 are two of the most interesting chapters in this book; both deal with the role of humoral theory in therapy. Contrary to what most anthropologists have argued, Foster claims that humoral theory plays a relatively small role in therapy. He began to consider this possibility after he became aware of anomalies in his Tzintzuntzan ethnomedical data. For example, (1) there was widespread disagreement among informants with respect to the humoral values of many common remedies, and prescribed and proscribed foods, and (2) many common therapies failed to conform to the principle of opposites prescription.Bilis for example, is thought to be due to an overflow of Hot bile from the liver into the stomach. Yet the ingredients most often mentioned by informants as a remedy for bilis are predominantly Hot (pp. 135-36). Foster believes that humoral theory validates rather than prescribes empirical treatments (p. 13 1).
Medicines are prescribed for well-known complaints with little or no thought given to their humoral consistency (p. 137). They are prescribed because there is the expectation, based on prior experience, that they will work (p. 138). Many therapies are consistent with humoral theory; many are not. Evidently, people uncritically accept humoral theory. They tend to remember or point out instances in which humoral theory is validated but ignore or only become vaguely aware of instances in which humoral theory is not supported.
After reading Foster's account about the validating role of humoral theory in therapy, I began to wonder about the role of other kinds of disease-causing theories in contemporary Nahua communities. In many Nahua communities witchcraft, soul loss, object intrusion, possession, breach of taboo, and ancestral spirits are believed to be causes of illness. What role do these kinds of personalistic theories of disease play in the prescription of medicinal therapy? We need to know more about what goes on in the minds of Nahua healers when they prescribe rituals and herbal medicines for different kinds of illnesses.
Chapter 8 details Foster's account of "how contemporary humoral medicine described by anthropologists in Indian, mestizo, and ladino communities in the Americas (and in the West Indies and the Philippines) [is] a simplified form of classical humoral theory and practice, which was brought to the New World by Spaniards and Portuguese" (p. 149). Chapter 9 argues that we should reject the view that humoral medicine in the Americas is an indigenous cultural trait (e.g., of pre-Hispanic Aztec origin) that after 500 years "of European influences remains so vigorous that it is still a major source not only of Indian but also of rural mestizo and urban popular medical practice" (p. 149).
Foster's "Filtering Down" model is a very plausible account of how many elements of an elitescientific medical system were transmitted to urban and rural settings in the New World. Foster makes extensive use of historical and comparative ethnographic data to show how humoral medicine in the
New World, taught "in medical schools until the early 19th century... diffused to a popular level through the ministrations of religious and medical personnel in hospitals and elsewhere, through pharmacies, and through home care manuals" (p. 150).
I agree with Foster that the American Origin models developed by Audrey Butt Colson, Alfredo Lopez Austin, and Bernard Ortiz de Montellano are problematic. For example, many "pre-hispanic" sources of medical information, even the very earliest ones, are not "pure Indian" in content. There is reason to believe they have been "contaminated" in varying degrees by European humoral theory and when humoral ideas are encountered in Aztec texts, it is difficult to pinpoint their origin. The American origins model can not account for the "remarkable homogeneity of humoral medicine in all Latin America, in the Caribbean, and in the Philippines. The same equilibrium model of health, the same Hot-Cold classificatory system, the same names of illnesses, the same remedies and therapies are all found throughout this immense area" (p. 158). In addition, if humoral beliefs and practices in Latin America are of indigenous (e.g., Aztec) rather than European origin, then it would be reasonable to expect that humoral ideas would be stronger or at least as strong among contemporary indigenous groups as among those of greater European ancestry. Available ethnographic accounts do not support this expectation. In fact, humoral ideas appear to be weakest in the most isolated Nahua communities (p. 164).
For more than fifty years, Foster has been thinking hard about the impact of Spain on indigenous American cultures such as the Nahua. This has involved him in an interesting debate with some of the most respected Nahua scholars including Lopez Austin and Ortiz de Montellano. Readers of the Nahua Newsletter should take note of this book because there is a lot that is worthy of emulation and admiration, It is cross-cultural in nature and deals with a topic that is of broad, general interest. Humoral medicine is a medical system that has existed for well over 2,000 years, and is arguably the longest lived of all scientific paradigms. Foster's book is based upon a solid empirical foundation and is full of insightful and clear analyses. This book embodies the very best in anthropology.
Brad R. Huber
College of Charleston
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