1.1 Hippocratic Precedents

As pointed out by Hellmut Flashar, the earliest instance of the word ‘melancholy’ is from the Hippocratic Airs, Waters, Places, which is dated among the oldest texts of the Corpus Hippocraticum.¹⁰ There, it is presented as a condition of illness that can be the consequence of very specific meteorological circumstances for people of a particular constitution. Among the many descriptions of variations in the qualities of seasons and winds that correspond to the manifestation of various diseases in people of particular constitutions, there is one that describes a dry autumn with a northerly wind, following upon a dry summer with a northerly wind:

ἢ δὲ βόρειόν τε ᾖ καὶ ἄνυδρον … τοῖσι μὲν φλεγματίῃσι φύσει συμφέρει μάλιστα καὶ τῖς ὑγροῖς τὰς φύσιας καὶ τῇσι γυναιξι· τοῖσι δὲ χολώδεσι τοῦτο πολεμιώτατον γίνεται. λίην γὰρ ἀναξηραίνονται καὶ ὀφθαλμίαι αὐτοῖσιν ἐπιγίνονται ξηραί, καὶ πυρετοὶ ὀξέες καὶ πολυχρόνιοι, ἐνίοισι δὲ καὶ μελαγχολίαι.¹¹

But if the weather be northerly and dry … it is very beneficial to those who have a phlegmatic or humid constitution, and to women, but it is very harmful for the bilious. For these dry up overmuch, and are attacked by ophthalmia and by acute, protracted fevers, in some cases too by melancholies.

tr. Jones

Due to these specific circumstances, the bilious types become excessively dry and thick in autumn, which can lead to melancholy. The constitutions that are relatively moist benefit from these same circumstances, but since the bilious types are already dry, their dryness becomes excessive and cause of disease.¹² All moisture in their bile and blood dries up, leaving behind only the thickest and most acrid parts of it.¹³

Notably, there is no mention of black bile (μέλαινα χολή) as a separate humour or substance in this text yet, there is only the alteration of the substances bile and blood. Still, the two processes of drying and thickening as well as the timing of autumn, also occur in On the Nature of Man. They will become a standard part of the tradition on black bile as a humour and are fundamental for Galen, as we shall see.¹⁴ There is also no mention of a ‘mental’ illness here yet, the melancholy seems to be conceived only in physical terms. The designation of this condition as ‘melancholy’ appears to be based in the blackening of the bile, which is the result of its drying and thickening. As Flashar notes, melancholy at first probably indicated not a state in which a particular humour called ‘black bile’ predominates, but rather a disease that is characterized by a blackening of the bile, the latter being in itself a normal part of the constitution.¹⁵

Melancholy quickly appears as a mental illness as well, one that is particularly related to the brain. In book III of the Epidemics, a patient’s state of mind is characterized as ‘melancholic’ after a list of symptoms have been summed up, all of which will become traditionally associated with melancholy:

κῶμα παρείπετο, ἀπόσιτος, ἄθυμος, ἄγρυπνος, ὀργαί, δυσφορίαι, τὰ περὶ τὴν γνώμην μελαγχολικά.¹⁶

Coma was present, aversion to food, despondency, sleeplessness, irritability, restlessness, the state of mind was melancholic.

tr. Jones

Thus, we find in the Hippocratic Corpus a notion of melancholy as a disease dependent upon specific meteorological and constitutional circumstances, a notion of melancholy as something that particularly disturbs the mind, and the relation of melancholy to a detrimental state of one’s bile, that is characterized by excessive drying and blackening. But do we find a notion of black bile as a substance that causes the mental illness melancholy? According to Flashar, we do not. He concludes: ‘Die Melancholie stellt sich zunächst dar als eine Krankheit, die ihre Ursache in einer schwarzen Verfarbung des Körpersaftes Galle hat’.¹⁷ Thus, it is rather the alteration of another substance that is seen as the cause of the disease called melancholy. However, Flashar also points to a development within the Hippocratic corpus, in which black bile evolves more and more into a substance in its own right, one that is part of our nature and that has the potential to cause melancholy.

Our previous quotation shows that in the Hippocratic Corpus the disease of melancholy has already assumed, in rudimentary form, the character by which it will be known for millennia to come. Its described symptoms are fear, despondency, sleeplessness, irritability, aversion to food, difficulty with speech or aphasia and possible derangement or delirium.¹⁸ Andrew Solomon seems to have been right about depression being as old as the hills. In the Hippocratic Corpus melancholy is also described as both manic and depressive, a feature that, as we shall see, will become established more strongly with the Peripatetic Problemata and that is at least to some extent comparable with present-day notions of the bipolar variety of depression. It is particularly related to the mind, more than other diseases, as also becomes clear from Epidemics VI, where it is said that there is some congruence or overlap between melancholy and epilepsy, but that those whose sickness tends more towards the body, become epileptics, while those whose sickness tends more towards the mind (ἡ διάνοια) become melancholics.¹⁹ This particular passage is picked up by Galen in Loc. Aff., as we shall see below.

The most concise and well-known description of melancholy can be found in the Aphorisms, unfortunately completely without context:

ἢν φόβος ἢ δυσθυμίη πολὺν χρόνον διατελῇ, μελαγχολικὸν τὸ τοιοῦτον.²⁰

If the fear or despondency lasts for a long time, this is a melancholic state.²¹

Galen cites this passage in various works and (partly due to Galen) these main symptoms will become an integral part of the tradition on melancholy, even still as descriptions of its modern successor, depression.²²

As a separate substance of its own, rather than a degenerated or detrimental version of the bile that is a normal part of our constitution, black bile seems to become established at first in the Hippocratic On the Nature of Man.²³ There are some other passages in the Hippocratic Corpus where there is mention of a black bile, but it is unsure whether it is considered as a separate substance there or rather as a specific form of the ‘normal’ bile. It is generally considered a harmful substance that manifests itself in situations of extreme illness. One reason, perhaps, to assume that there was no concept of black bile as a separate substance in the earlier treatises of the Hippocratic Corpus until the On the Nature of Man, is that in other treatises we find enumerations including all of the canonical humours except black bile.²⁴

In On the Nature of Man and Galen’s commentary on it, we find a systematization of the humours into a fourfold schema integrated with the four elemental qualities and the four seasons in the following manner: phlegm is cold and wet and predominates in winter; blood is warm and wet and predominates in spring (but blood also has an exceptional position, as we shall see below); yellow bile is warm and dry and predominates in summer; black bile is cold and dry and predominates in autumn. Together, these four humours constitute our nature; when they are mixed in a proper balance, we are healthy, while the various diseases are explained in terms of their respective predominance. As is well known, this fourfold schema will become canonical after Galen and thus crucial for the history of black bile and melancholy in general. Galen will also extend the analogies with age: blood predominates during infancy, yellow bile predominates in youth, black bile predominates during the period after one’s prime, phlegm predominates old age; as well as with taste: blood is sweet, yellow bile is bitter, black bile is sharp or acid, phlegm is salty; and the elements: yellow bile corresponds to fire, black bile to earth, phlegm to water and blood to a well-balanced mixture of the four.²⁵ This schematization is fundamental for the history of black bile and melancholy, since black bile would otherwise not be considered a common part of our constitution. With the inclusion of black bile in this basic schema that describes our common nature, black bile and melancholy acquire the potential to become a normal part of our constitution in the centuries to come.

Müri and Flashar see the addition of black bile to the other humours, which were older and more commonly established notions, as ‘Systemzwang’ or ‘Systemtrieb’, that primarily served to integrate the schema of the humours with that of the four seasons and that of the four elemental qualities.²⁶ That might seem a proper explanation, especially since it seems that previously there was no black bile in its own right, while the other fourfold divisions were already in place. But the question still remains: even if we assume it logical to add a fourth for the sake of systematization, why this one? After all, there were many recognized forms and shades of bile and other humours or bodily juices. Morever, there was little or no empirical evidence for black bile.²⁷ As Jouanna has pointed out, the humoural theory of the Hippocratic On the Nature of Man was ‘just one humoural theory amongst others’. He gives an example with the Hippocratic Diseases, in which water takes the place of the fourth humour, rather than black bile.²⁸ The competing theories, however, did not leave a such a legacy as that of the On the Nature of Man. Stewart also emphasizes that the humoural system of the On the Nature of Man was not the ‘dominant humoral theory’ in ancient medicine, but that its uniqueness consisted in the constructed correspondence to the four seasons and the stages of life. However, he then simply adds: ‘It is also important for the status of black bile, which is defined as an element of the body, as opposed to a pathogenetic residue that is produced from the alteration of another substance’.²⁹ The importance of this systematization for the status of black bile is undeniable, but the question still remains: why was it, then, that the humoural theory that added black bile became so successful? Why was the choice for black bile such a success? Why would the blackened bile, which was previously considered a cause of disease rather than a normal part of our nature or constitution, be a suitable candidate to expand the humoural schema in the first place? It had negative associations from the start, why incorporate this detrimental dark substance into the nature of healthy human beings? Stewart’s work is mostly concerned with the historical importance of Galen’s interpretation of black bile and his manipulation of the previous history into something that aligns with his own theory. Galen, in his commentary on On the Nature of Man (HNH), argues that the text was the foundation of Hippocrates’ work and with his own authority ensured its legacy – that much is sure. He emphasizes its importance and attributes it to a host of other prominent physicians and philosophers without proper justification, to portray the theory as universally adopted, as Stewart notes.³⁰ Thus, we have noted that Galen played a crucial role in the installation of this humoural theory, which was to play such a dominant role in later history. But, that is not an answer to our previous question: why could this humoural theory, the one that included the black bile, have been so attractive in the first place, for Galen and the later tradition alike?³¹ It seems insufficient to answer this question merely in terms of Galen’s authority and his apparent liking for Hippocrates in general or the On the Nature of Man in particular, especially considering the interest that melancholy as a disease (by then related to black bile) already had well before Galen, as we can observe for instance in the Problemata and in Rufus’ work (with which Galen was thoroughly familiar). On this question, I think, Kudlien’s study still provides a more useful point of departure.³² Kudlien points to a general appreciation in ancient Greek culture for something dark that causes madness, something that is associated with anger (χόλος), spilled blood, earth and the diaphragm. He argues that this appreciation existed prior to the establishment of black bile as a proper substance in itself and facilitated its conception.³³ According to Kudlien, these pre-Hippocratic, non-medical precedents need to be taken into account, since the more technical medical notion of black bile builds on them. As he sees it, these precedents leave an ‘inherited conglomerate’ – as he calls it, after a notion developed by Dodds – that paves the way for the later inclusion of black bile among the canonical constituents of the human body. Likewise, Klibansky, Panofsky and Saxl, in their Saturn und Melancholie point to these kinds of pre-scientific associations with black bile, which ‘schon durch seinen Namen (μέλας = schwarz) mit allen bösen und nächtlichen Vorstellungen verknüpft war’. They remark, rightly so in my opinion, that the scope of meaning of the word μέλας in Greek, as in most other languages, is far wider than a mere designation of colour, and that this is a fact of relevance for the study of the history of black bile and melancholy.³⁴ In Aretaeus of Kappadocia, we find an explicit connection of black bile to the Homeric χόλος, in which the addition of blackness would express a more vehement or violent anger than the normal bile.³⁵

Besides having an obvious methodological advantage, namely that Kudlien is able to explain to some extent why black bile was an attractive option to include into the basic human constitution beyond a mere reference to Galen’s authority and his liking of Hippocrates, Kudlien also makes a solid point about the precedents. In fact, people have remained fascinated by the substance of black bile as a part of our constitution for hundreds and almost thousands of years after Galen – does an appeal to Galen’s authority suffice to explain this, or should we look further into what might make the notion of black bile so appealing? In the chapter on black bile in Galen below, we shall further delve into the primary associations that black bile evokes in Galen’s work in order to better understand its attractiveness. For now, I would merely make the general suggestion that there was something interesting and attractive about the incorporation of black bile into our constitution, because it effected a physiological integration of a darker side of the life of human beings into the medical and philosophical conceptual framework, a side that was associated with death, madness, heaviness and the dark depths of the earth. This is not an anachronistic projection of more modern notions of melancholy unto Galen, as we shall see, since all of these associations can already be found in Galen’s own work. When he cites the Hippocratic passage that identifies fear and despondency as the two main symptoms of melancholy, he explains these symptoms in terms of the darkness of the black bile. He even compares the person afflicted by melancholy to a child wandering in external darkness.³⁶ There is, then, a clear association in Galen of melancholy with the dangers of night and death, and the experience of these dangers has been fundamental for human beings from time immemorial.

We shall continue this line of thought in the section on black bile in Galen. To conclude this section, we find in the Hippocratic Corpus two possible causes of melancholy: the drying and thickening of bile that becomes black as a consequence of excessive heating of another humour, and the excess or isolation (i.e. not being mixed with other humours) of black bile as one of the four humours that need to be balanced in order for there to be health. These two options seem to be the consequence of black bile first appearing as a degeneration of normal bile and then becoming integrated into a more systematic humoural theory, to some extent already in the Hippocratic Corpus. They remain in tension in the tradition building on the Hippocratic Corpus, as we shall see, and will also resurface as the tension between an extremely harmful and more normal version of black bile. We have also seen in this section how melancholy is specifically associated with the mind and with the symptoms of fear and despondency from its inception. Finally, we have had a brief discussion on the possible underlying reasons for the attractiveness of black bile as a normal part of our constitution, which will be continued later.

1.2 Aristotle and the Problemata XXX,1

The so-called Problemata Physica have had a profound impact on the history of black bile and melancholy with its bipolar-like description of a melancholy genius exemplified by various poets, heroes and philosophers. It was commonly attributed to Aristotle until 20th century scholars have made a convincing case that it is in all probability not a work by Aristotle himself but more likely by his successor Theophrastus or another Peripatetic.³⁷ It contains a single chapter (XXX,1) devoted to melancholy, which was to exercise a major influence, particularly on the Renaissance association of melancholy with genius and the subsequent romanticisation of melancholy.³⁸ The theory of melancholy in the Problemata has recently been compared to Aristotle’s genuine work in a seminal study by Philip van der Eijk, showing that it depends on Aristotle’s notion of the melancholic in some aspects, and could be a continuation of Aristotle’s own work or thoughts in this regard.³⁹ In the following section on Aristotelian precedents for Galen’s theory of black bile and melancholy, we shall build on van der Eijk’s work in order to provide a brief overview of both, starting with Aristotle’s genuine work and then proceeding to a discussion of the Problemata chapter XXX,1.

1.3 Rufus of Ephesus

The physician Rufus of Ephesus, whose work is mostly dated to around the turn of the 1st century AD, was perhaps Galen’s most important predecessor on the subject of black bile and melancholy.⁸³ Galen mentions him as the best of ‘the more recent writers’ on the subject at the start of his own On Black Bile, and even remarks that for those willing to listen there is nothing missing from Rufus’ treatise.⁸⁴ Coming from Galen, this is certainly exceptional praise for someone who is not Hippocrates or Plato. Rufus wrote two books on melancholy, of which we now only have fragments, mostly in Arabic. These fragments have been collected in an excellent edition with translation and commentary by Peter Pormann, which also includes additional essays by other scholars on Rufus and melancholy.⁸⁵ According to Pormann and van der Eijk, Galen’s writings on melancholy in Loc. Aff. rely on Rufus’ work to a large extent, and might indeed be ‘little more than a Galenic summary of Rufus’ ideas on the topic without proper acknowledgement’.⁸⁶ Hence, it will be useful, to say the least, to discuss Rufus’ work before we turn to Galen himself.

1.4 Conclusion

Much, if not most, of what Galen writes on melancholy (particularly in Loc. Aff.) is at least prefigured in Rufus. Galen seems to inherit from Rufus his main distinction between two different kinds of black bile: one that is like a sediment in the blood and one that is caused by burning. He also seems to take over the distinction between three different kinds of melancholy, namely, hypochondriac, encephalic and general. Rufus strongly emphasizes the association with digestion, which we previously found in Aristotle as well, and also associates it with the spleen.¹³³ The apparent reciprocity between physiological and psychic states will also recur in Galen. The association of melancholy with thinking will recur in a slightly different form. It is more dependent upon a broader schema of the relation between elemental qualities and humours on the one hand and psychic capacities on the other, and it differs from Rufus because the thinking is less particularly associated with scientific thinking. As far as I can tell on the basis of the extant fragments collected by Pormann, there are a few aspects in which Galen changes, systematizes and adds to the Rufian fundament, which certainly must have formed his point of departure. Some of these aspects have to do with Galen using a more systematically developed humoural theory, in which black bile is not only dry and cold, but also belongs to autumn, is ill-tempered, earthy and obstinate. As such, it is opposed to blood and spring, which are considered beneficial, and opposed to yellow bile, which stimulates activity and thinking. This allows Galen to further integrate black bile into a microcosmic schema, in which it is a regular part of us, while it is at the same time opposed to the most useful or beneficial parts of us. As we shall see, in Galen, black bile acquires a regular place among the qualities, elements and time-periods in which the order of the cosmos consists. This also extends to the role of the spleen, which, as it seems for the first time, becomes the organ specifically attributed to us in order to purify our blood from black bile. Galen also seems more successful than Rufus in explaining the cause of melancholy in terms of the darkness of its substance. He achieves this partly by further developing the hypochondriac kind of melancholy on the basis of Diocles and Rufus’ work. Through a comparison with the external darkness that we all experience, Galen achieves a normalization of melancholy that we did not find in the extant fragments of Rufus yet. But we may be getting ahead of ourselves now. It is time to analyse the notions of black bile and melancholy in Galen’s work, first.

After brief discussions of black bile and melancholy in the Hippocratic Corpus, the Peripatetic tradition and Rufus, we are now sufficiently equipped to look at Galen’s writing on black bile and melancholy. Many of the themes and distinctions that we have pointed out before shall recur in our discussion of Galen, whose work with regard to this subject, too, can be seen as a synthesis of the preceding tradition.

2.1 Introduction

We have seen, in the brief overview of Galen’s main precedents, that black bile had become an ambiguous substance. On the one hand it is a dangerous substance that is primarily associated with serious disease; on the other hand – especially under the influence of the late Hippocratic On the Nature of Man – it is also one of the four humours and as such a normal part of our constitution, healthy or otherwise. This is a tension that culminates in Galen’s work, in which black bile is essentially both of these things.

It has been observed that the theory of the four humours as it has come down to us via On the Nature of Man, was one humoural theory among many and did not have a dominant role until Galen.¹³⁴ Galen argued in his commentary on the treatise and elsewhere that it was the foundation of Hippocratic medicine and he contributed greatly to the ensurance of its legacy through both a further systematization and a consistent depiction of the theory as something widely shared by all previous philosophers and physicians held by him in high regard.¹³⁵ As in many other cases, Galen managed to successfully present his own theories – that often synthesize various previous ones into a more or less original Galenic whole – as the right continuation of previous authorities, ensuring their canonization in centuries to come.¹³⁶ Thus, however many competing humoural theories existed and whatever they consisted of – we will not discuss them here – they all became obscure, while Galen’s humoural theory became the humoural theory. As we have noted, this particular historical contingency was conditional for the systematic inclusion of black bile into our body. It was likely also conditional for the notion of melancholy as something that is a part of human nature, and as something that is to a certain extent a regular and normal part of our lives as opposed to merely a dangerous disease that arises in exceptional circumstances. The identification of fear and despondency as the main and basic symptoms in the Hippocratic Corpus, taken up by others such as the author of the Problemata and Rufus, certainly must have helped in this regard: everybody is fearful and despondent at times. But, despite the existence of melancholy as a particular affection that is not necessarily dependent on a systematic humoural theory, I think it is safe to say that without Galen’s canonizing incorporation of these symptoms into an enigmatic black substance that we always carry around, much of the later history of melancholy, including its romanticized forms, becomes much harder to conceive of.

In this chapter, we shall discuss Galen’s notion of black bile and his attempted synthesis of the various forms of black bile that we have encountered among his main predecessors. Several aspects of black bile seem to run through Galen’s work and they cannot always be distinguished in a straightforward manner. There is the black bile that is one of the four humours, associated like the others with its own season and stage of life. We find it in Galen’s more systematic works such as his commentary on On the Nature of Man (HNH) and his On the Elements According to Hippocrates (Hipp. Elem.). But there is also the black bile that is a kind of residue of digestion and that is distributed from the liver to the spleen as a side-effect of the production of blood, which we have found, in more rudimentary form, in both the Peripatetic tradition and Rufus. There is a black bile that Galen describes as a kind of ‘sediment’ of the blood that is only harmful in large quantities, which corresponds to the way Rufus describes one of the two kinds of black bile. But there is also a black bile that is a result of the burning of yellow bile, or a black bile that is completely unmixed. The latter two are deadly even in small amounts. The black bile that results from heating is something that we have also encountered before, both in Rufus and in the Problemata. In the latter it could have significantly positive effects. How do all of these black biles relate to each other? Is there anything common about all of them? How can black bile be both so harmful and so common? What role do the qualities of hotness and coldness play in Galen’s writings on black bile? What role do the various seasons play? How is black bile related to digestion and the spleen? These are the questions that we shall discuss in the following paragraphs. Galen is, if anything, a great synthesizer of various previous traditions, medical and philosophical, and he knew all of the discussed precedents well. It will turn out that the types of black bile found in Galen, all of which we have by now seen prefigurations of, can be usefully distinguished along the line of the ‘normal’ and the ‘harmful’, or what Galen himself sometimes calls κατά φύσιν and παρά φύσιν.¹³⁷ Although Galen distinguishes the harmful and normal variants of black bile, they show much common ground as well. As we shall see, both can be designated either as black bile or as a melancholic humour, that is, by the same name. What is perhaps most striking in Galen’s treatment of black bile is both the extent to which black bile is a normal substance that is potentially harmful, as well as the extent to which the harmful potentiality of black bile is a normal part of our constitution. This is what makes black bile exceptional compared to the other humours, particularly in its opposition to blood, an opposition which becomes more important in Galen.

After discussing the varieties of black bile, we shall devote a separate paragraph to the spleen, further systematized in Galen as the organ that draws the black bile to itself and cleanses the blood from it, to prevent it from dominating the body. Though Galen apparently deems the production of a pernicious substance such as black bile necessary, he also observes that Nature – in accordance with her providential character – made up for it to some extent by supplying us with an organ that cleanses our body of it. In this manner, the integration into our nature of an essentially harmful substance that does not seem to do us much good by itself, is reconciled with Galen’s teleological framework through the synchronic introduction of its own cleansing instrument – the spleen. The association of black bile with the spleen, too, becomes a canonical element of the subsequent tradition. Again, there are precedents, as we have seen in Rufus, but the canonization of the relation between spleen and black bile and between spleen and melancholy, is hard to conceive of without Galen. Finally, after having laid the physiological basis, we shall look into the more or less symbolic associations that black bile evokes, its field of meaning, so to speak, taking our lead from the associations of black bile with a specific season and stage of life, as well as its relation to the other humours and its peculiar qualities of coldness, dryness and thickness. It will become clear that black bile has an exceptional position in Galen’s humoural theory as the humour opposed to blood, which is identified as the most important, beneficial and useful humour. It is associated not only with darkness and earth, but also with death. In our analysis, black bile appears as the remnants of a fire that has been quenched, as that which remains after summer ends – the stubborn and static remnants of excessive sun that now hinder the flow of the substance that gives us life by weighing it down. It is, as it were, the physiological substantiation of our finitude, of the mortality that is a continuous part of our life as its limit and opposite, and which requires continuous care so as not to become definite.

2.2 The Normal and the Harmful I: the Normal

Galen devoted a short treatise to the subject of black bile, in which he focuses almost exclusively on the substance itself and its various detrimental effects. A discussion of melancholy is absent here. The work is called On Black Bile (περὶ μελαίνης χολῆς; abbreviated after the Latin as At. Bil.) and is included in the Kühn edition (V 104–48). A later edition by de Boer appeared in the CMG and there is also a French translation by Barras, Birchler and Morand, as well as an English one by Grant.¹³⁸ The question of the authenticity of this treatise has recently been raised and answered favourably by Jouanna in an insightful article, the main proof for its authenticity being Galen’s own reference to it in Prop. Plac.¹³⁹

What comes to the fore most prominently in this short treatise is the ambiguity between black bile as a common and necessary part of our constitution, and black bile as a destructive and malignant substance that causes disease and death, the same ambiguity that we have referred to earlier.

At the beginning of At. Bil., Galen singles out his predecessors: Rufus, as one of ‘the more recent writers’ and, unsurprisingly, Hippocrates himself as well as some of his alleged pupils. He then immediately integrates the subject of his treatise in his general humoural theory, which he developed in HNH, by first describing the outward appearance (ἰδέα) of each of the four humours with descriptions that are congruent with those of HNH. This is an important step, since such a humoural theory was absent in the Peripatetic tradition on melancholy and we find merely a few scarce allusions in the fragments that we have of Rufus.

Blood has an exceptional position in Galen’s humoural theory. In At. Bil., he starts with the description of blood, since it is the ‘best known to everyone’. It is generally red, but can also appear somewhat more yellowish or black. Its taste is generally sweet while its thickness also varies. In fact, ‘whatever pours out of the veins and the arteries’, says Galen, ‘however it might look’, is simply called blood.¹⁴⁰ Further on in the same treatise, however, Galen remarks that ‘from the diversity of colour and consistency it is revealed that all the humours are contained within the veins and arteries’.¹⁴¹ That might seem like a contradiction: on the one hand, everything that pours out of the veins and arteries is blood, while on the other hand all the humours are contained in the veins and arteries. However, it simply implies that there are two kinds of blood, or that the word ‘blood’ can designate two kinds of things: 1. blood in a strict sense, as unmixed with the other humours; 2. blood in a broader sense, as the mixture of four humours of which blood is the most important.

This also corresponds to the picture we find in HNH, where Galen more explicitly distinguishes these two kinds of blood. First, when he refutes the notion that man consists of only one humour, he remarks that the ones who claim that blood is the only humour are more difficult to refute than those who choose whichever one of the other humours.¹⁴² The main empirical argument against the view that there is by nature only one humour in the human being and that this humour is blood, is based on the observed results of purgative drugs: if people are given certain drugs, it can be observed that they evacuate phlegm or bile, whatever their age or the season.¹⁴³ That means that these fluids must be contained in the body at all time. However, that does not mean that they have the same status as blood:

διττῶς δὲ τοῦ αἵματος λεγομένου, τοῦ μέν, ὅπερ ἐν ταῖς φλεβοτομίαις κἀν τοῖς τρώμασι κενούμενον φαίνεται, μετέχοντος, ὡς ἐδείκνυμεν, ἀμφοτέρων τε τῶν χολῶν καὶ τοῦ φλέγματος, ἑτέρου δὲ τοῦ καθαροῦ τε καὶ εἰλικρινοῦς ἀμίκτου τε τῶν ἄλλων χυμῶν …¹⁴⁴

But we talk of two types of blood: one which is manifestly evacuated as a result of phlebotomy and wounds, and which contains a portion, as we have indicated, of both types of bile and of phlegm; while the other is pure, unadulterated, and unmixed with the humours.

tr. Hankinson

The first type of blood, which is what we commonly know as blood, is only called ‘blood’ because it is, as Galen remarks, ‘predominantly’ blood. That is to say, it is a mixture of all four humours in which blood, in the purer sense, predominates.¹⁴⁵ The blood of a living being, however, will never merely consist of this pure form of blood and it is from blood in the mixed sense, states Galen, that the foetus is likely to be formed.¹⁴⁶ That is to say: the other humours are always already mixed in the blood of a human being and their distinction is dependent on the empirical data of the purging. So the solution of the potential contradiction that we find in At. Bil. consists of the discovery of a homonymy, but not a mere homonymy. The mixture of all humours is also called blood, after one of the elements of the mixture itself, because blood is the most important humour:

μετὰ τὸ κενωθῆναι τὸν οἰκεῖον τῷ καθαρτικῷ φαρμάκῳ χυμὸν ἐφεξῆς αὐτῷ πρῶτος μὲν ὁ τῶν ἄλλων εὐαγωγότατος ἕπεται, μετ΄ ἐκεῖνον δὲ ὁ τὴν δευτέραν ἐπὶ τούτῳ τάξιν ἔχων, κἄπειτα τὸ αἷμα πάντων ὕστατον, ὡς ἂν οἰκειότατος ὢν τῇ φύσει χυμός· ἀσφαλὲς γὰρ φάναι περὶ αὐτοῦ τὸ γε τοσοῦτον, ὡς, εἰ καὶ μὴ μόνος ἐστὶν ἡ φύσις τοῦ ἀνθρώπου, ἀλλ΄ οἰκειότατός γε ἁπάντων τῶν ἄλλων.¹⁴⁷

After evacuating the humour which is most closely affiliated to the purgative drug, next in order there follows first the one humour among the others which is most easily attracted by it, and after that the second after it in this ordering, and then blood last of all, since it is the humour most closely affiliated to the nature (of man). For it is at any rate safe to say about this one, that it is, if not the sole constituent of the nature of man, then at least the most closely affiliated to it of all the others.

tr. Hankinson

The mixture of the humours derives its name, blood, from its predominant substance, blood in a stricter sense. There are other things in the blood besides blood in a strict sense and there is empirical evidence of those things due to the possibility of evacuation of phlegm and bile with purgative drugs, but these things are clearly not on a par with the blood. They fulfil a less important role than the blood itself.¹⁴⁸

Unsurprisingly, Galen does not always distinguish between these two notions of blood as neatly as in the texts just quoted. Elsewhere in HNH, when he enumerates the respective elemental qualities of each of the humours and arrives at those of blood, he remarks that since blood is the most well-tempered, none of the elemental qualities in it predominates greatly relative to the others. A little earlier, however, he simply attributed to blood the elemental qualities of hot and wet (this may be explained in terms of the difference between Galen’s interpretation and the Hippocratic text, which does attribute to blood the qualities of hotness and wetness).¹⁴⁹ In fact, Galen says, since blood requires all four qualities in a certain balance, the most well-tempered blood must also contain the other humours.¹⁵⁰ The reasoning in this latter passage is not entirely clear, but it is clear enough that the role of blood is ambiguous in Galen, because it is a humour among others on the one hand, but that which contains the other humours on the other. It is also clear enough that its latter role is explained not merely in empirical terms of a measured quantity, but rather in terms of its exceptional importance and well-tempered nature. There are also other ways in which blood is different from all three other humours: the other three are said not to congeal and they are often described as περιττώματα, residues of the process of digestion, which is actually aimed towards the production of blood. This is something that we need to keep in mind, as it will become relevant for our analysis of black bile, since Galen opposes black bile to blood.¹⁵¹

Next to be described in At. Bil. is phlegm. It is said to have no particular taste of itself but to be able to take on a variety of tastes. Regardless of the particular taste it displays it can be called phlegm as long as ‘it is white’.¹⁵² As opposed to blood, it does not congeal, which is, as we have just noted, actually a property that distinguishes all other humours from blood. The description of phlegm too, corresponds to that in HNH, where phlegm is also simply described as ‘white’ and where its variety in taste is emphasized as well.¹⁵³ It is also characterized in terms of the elemental qualities and seasons as being particularly cold and wet and predominant in winter.¹⁵⁴

Yellow bile is described as bitter and, like blood, displays some variety in colour and thickness. It becomes paler in colour and softer in consistency, less thick, to the extent that it contains more moisture. Eventually it could become as white and soft as the yolk of an egg. It is particularly related to the gall bladder, which is the organ that seems to take in the yellow bile after its generation in the digestive process.¹⁵⁵ Again, this seems consistent with what we find in HNH, where yellow bile is also described as bitter, and comparable remarks about its variation in colour and thickness can be found as well.¹⁵⁶ Its season is summer, and its elemental qualities are dry and hot.¹⁵⁷ Yellow bile has a peculiar relation to black bile, as we shall see below. It can become black by excessive heating, which must not be considered a rare phenomenon, it seems, given its abundant presence in summer, which also happens to be the season preceding autumn, the season of black bile.

So far, except perhaps for the ambiguous nature of blood, Galen’s descriptions of the humours have been fairly straightforward and in line with his other works, not providing us with much interpretative difficulty. When it comes to the black bile itself, however, the matter seems to become somewhat more complicated.

In HNH it is simply described as black, sour or sharp (ὀξύ) and as having a thicker consistency than yellow bile.¹⁵⁸ Its season is autumn and its qualities are cold and dry, while it is also said to be ‘earthy’ (γεῶδες).¹⁵⁹ Although it has its specific season in which it predominates and is more abundantly present – as do each of the other humours – it is a regular part of the human constitution in every age and season as well – as are each of the other humours.¹⁶⁰ In Galen’s commentary on the Hippocratic On the Nature of Man, each humour has its own combination of elemental qualities and seasons, creating an elegant whole by each providing an equal portion. There is at least a hint of a schematic association with the elements, as well, which seems to be based on the congruent descriptions of elemental qualities. Black bile is said to be earth-like, as we just mentioned. In PHP Galen is more explicit about this and completes the entire schema: yellow bile is analogous to fire, and phlegm to water, while blood has an exceptional role here as elsewhere and is said to consist of a balanced mixture of all four elements.¹⁶¹ This understanding of the humours is not restricted to HNH. We find it in many Galenic works, also sometimes extended to an analogy with the stages of life.¹⁶² In this schema, the four humours together constitute our nature (although, as we saw, there is an exceptional role for blood). When they are mixed in a balanced manner, we are healthy. Disease is the consequence of a relative imbalance or an isolation of one of the humours. Thus, in the Hippocratic treatise black bile simply appears as one among four and Galen, in his commentary, mostly seems content to leave it this way. There seems to be nothing to suggest that black bile is particularly dangerous or malignant compared to the other humours. Galen even remarks that a complete absence of any one of the humours, including black bile, would cause a human being to die.¹⁶³ Black bile appears as a necessary constituent of our nature that is always present to some extent and without which we could not live.

In At. Bil. on the other hand – and this is where the complexity enters – Galen distinguishes between a black bile that is common to everybody, including healthy people, and black bile in a stricter sense, which is extremely detrimental. There is still a notion of a black bile that is always present as a normal part of our constitution – Galen even cites from On the Nature of Man and uses the same Hippocratic argument of purgation, which shows that each of the humours is present in us at all times.¹⁶⁴ But, there is also a black bile that is so utterly harmful and destructive that it can be considered as something opposed to life itself, comparable to the Dead Sea.¹⁶⁵ In his conclusion, at the end of the treatise, Galen still maintains that both of them – the normal and the harmful black bile – can be called by the same name, despite these profound differences:

καὶ μέντοι καὶ παρὰ τὴν ὁμωνυμίαν ἑαυτοὺς, οὐ γὰρ ἡμᾶς γε, σοφίζονται, τὸν μελαγχολικὸν χυμὸν, ὅν ἐν τοῖς ὑγιαίνουσι γεννᾶσθαί φαμεν, ἀκούοντες ἀεὶ κατὰ τῆς μελαίνης λέγεσθαι χολῆς, ἥν ἐν τῷ παρὰ φύσιν ἔχειν γεννᾶσθαί φαμεν. oὐ γὰρ ἡ αὐτὴ κατά γε τοὺς ἀκριβως ὑγιαίνοντάς ἐστι μέλαινα χολὴ, καὶ τινας τῶν παρὰ φύσιν ἐχόντων, ἀμφοτέρας δὲ μελαγχολικὸν χυμὸν ὀνομάζειν οὐδὲν κωλύει.¹⁶⁶

And through homonymy they play tricks on themselves, but not on me, with regard to the melancholy humour, which we say is produced in the healthy, since they always understand what is said in relation to the black bile, which we say is produced in those that are in an unnatural state. For it is not the same black bile in those who are perfectly healthy and in some of those who are in an unnatural state, but nothing prevents us from naming both of them melancholy humour.

The solution is, again, as it was in the case of blood, one of homonymy: the detrimental substance that is unnatural (παρὰ φύσιν) and the regular humour that is always a part of our nature, can be called by the same name, even though they are so different.¹⁶⁷ In this manner, both the systematic humoural theory of On the Nature of Man and the tradition of black bile as something causing disease – melancholy in particular – can remain in place. We can already see here how this particular synthesis has the potential to normalize melancholy. But let us first look at how Galen further defines these two kinds of black bile in At. Bil. It will turn out that in the case of black bile too, as in the case of blood, the homonymy that allows the different types to be called by the same name, is far from a mere homonymy between two things that have nothing else in common.

2.3 The Normal and the Harmful II: the Normal That Is Potentially Harmful

When Galen arrives at the description of the outward appearance (ἰδέα) of black bile in At. Bil., he first notes that it must be distinguished from dark blood.¹⁶⁸ This is interesting, since we noted before that blood changes its colour and, in particular, can become more yellowish or black. Since blood is a mixture of the four humours in which pure blood predominates, it would make sense for the blood in this broader sense to become darker when black bile predominates.¹⁶⁹ Darkened blood, however, might point to an atrabilious condition or a relatively large amount of black bile in the blood, but is not to be identified with the black bile itself.¹⁷⁰ Also, other black substances that frequently appear in vomit and faeces are to be distinguished from black bile proper, as can be seen not only from their specific powers, but also their observable qualities:

οὔτε γὰρ στρυφνότητος, οὔτε ὀξύτητος μετέχει σαφῶς ταῦτα, τῆς μελαίνης χολῆς κατά τε τὴν γεῦσιν ἐμφαινούσης τοῖς ἐμοῦσιν αὐτὴν καὶ κατὰ τὴν ὄσφρησιν, οὐκ ἐκείνοις μόνον, ἀλλὰ καὶ τοῖς ἄλλοις. οὐ μήν οὐδὲ ζυμοῖ τὴν γῆν, ὡς ἐκείνη.¹⁷¹

They certainly do not have any sourness or sharpness, whilst black bile exhibits these qualities through two senses: taste, for those who vomit it up, and smell, for the same people and those around. But it does not react with the earth to produce effervescence, as black bile does.

tr. Grant

Black bile is described here as sour and sharp or acid, descriptions that we also find in HNH and other works. Furthermore, it is said to produce some kind of peculiar effect on the earth, described by the verb ζυμόω, translated by Grant as ‘to produce effervescence’, meaning ‘to leaven’ or ‘ferment’.¹⁷² In the Hippocratic Diseases II, a similarly odd effect of black bile (or another black substance) on earth is mentioned: there it is said that the earth is raised by black material that is vomited (τὸ ἔμεσμα τὴν γῆν αἴρει).¹⁷³ The verb is also used in the Hippocratic Regimen in Acute Diseases LXI, where it is said that those who suffer from black bile are not benefited by the acidity of vinegar – as opposed to those who suffer from bitter bile – because it will make the black bile ferment and rise and multiply (ζυμοῦται καὶ μετεωρίζεται καὶ πολλαπλασιοῦται).¹⁷⁴ In Plato’s Timaeus we find it as well: certain vessels of air that are of earthy nature can cause a kind of boiling and fermenting because of their acidity.¹⁷⁵ Apparently the general idea is that the acidity of the black bile has some kind of corrosive effect on earth, which may also be associated with the acid that can rise from the stomach and be vomited out. We find the same description of the effect of black bile on earth in Nat. Fac. as well, including the comparison with vinegar, and in Loc. Aff., in a passage we shall discuss below.

In At. Bil., Galen now also compares black bile to a very sharp vinegar, noting its difference from it in terms of thickness. Black bile is a more dense substance, which causes it to settle in the body, whereas vinegar would pass through. Clearly, we are talking about the detrimental and harmful form of black bile here. But the thickness is, again, a quality that we also encountered in HNH. That is to say: besides the blackness and the sourness or acidity, this is another aspect that shows that the normal and the harmful black bile share more than merely a name. Since the black bile, as opposed to vinegar, settles because of its thickness, it can completely consume those parts of the body that it associates with in an unmixed state. The depiction of unmixed black bile that Galen gives now is one of an utterly deadly substance, one that no living creature would go near. In this respect he compares it with the Dead Sea, a water so salty that no living being survives in it.¹⁷⁶ Galen now seems to realize that some further explanation is needed. Is it not curious, that a substance of such description is part of the common constitution of all human beings? This is where he clearly distinguishes between two different kinds of black bile:

πολὺ δὲ δήπου τῆσδε τὴν ἐκ τῆς ξανθῆς χολῆς ὑπεροπτηθείσης γινομένην μέλαιναν ὀλεθριωτέραν εἶναι νομιστέον, ὅσῳπερ καὶ ὁ χυμὸς τοῦ χυμοῦ δραστικώτερος, ἡ ξανθὴ χολὴ τῆς οἷον ὑποσταθμης τοῦ αἵματος …¹⁷⁷

You must remember, of course, that black bile which results from an excessive heating of yellow bile is more destructive than the black bile I mentioned before, just as one humour is more drastic in its action compared with another fluid, by which I mean yellow bile compared with a fluid that looks like the sediment of blood.

tr. Grant

This utterly destructive kind of black bile Galen just described is actually the result of excessively heated yellow bile. This is what Galen seems to designate as black bile in the proper sense. Its destructive power is related to the active power of yellow bile: since it is a kind of degenerated form of yellow bile, one that has become overheated, it becomes malignant; but it becomes powerfully malignant since yellow bile is the most active humour. This is important to note, since the hot aspect in the bipolar-like descriptions of black bile in the Problemata and Rufus were related to quick and intense movement, as well as to intellectual activity, as we have seen. The black bile that Galen distinguishes here as the most dangerous one, is a degenerated form of a humour that is pre-eminently active. The yellow bile is defined as particularly active compared to the black bile that Galen ‘mentioned before’, as he says here. This black bile must be the one that appears as black bile, although it is not strictly speaking black bile: the black substance that appears similar to thick dark blood and sometimes appears in vomit and faeces, sometimes affording a sharp and sour sensation.¹⁷⁸ Galen now calls this more common substance a kind of ‘sediment in blood’ and contrasts it to the genuine black bile that is extremely detrimental. Here we have the same distinction that we previously found in Rufus: between a black bile that is like a sediment and becomes harmful only in particular circumstances; and a black bile that is the result of burning and that is harmful per se. For most of the rest of the treatise, Galen will continue to discuss the more common version of black bile rather than the harmful result of the overheating of yellow bile. What is this substance and how does it relate to the black bile of HNH, the black, sour, thick, dry and cold substance that forms a normal part of the healthy human constitution and predominates in autumn?

It is different from what Galen calls ‘black bile in the precise sense’ (τῆς ἀκριβοῦς μελαίνης χολῆς), which is always fatal, as he emphasizes.¹⁷⁹ This distinction is common throughout Galen’s work. The black bile that is like the sediment of the blood is often compared by him to the lees of wine. It is a residue and a by-product of the production of something essential, namely blood, or wine in the metaphor, and it is contrasted with what he calls black bile in the precise or proper sense (ἀκριβής).¹⁸⁰ If this sediment comes to be in excess, however, it can cause all kinds of serious afflictions. When it is isolated (from the other humours) it can cause a ‘dark tumour’ that can grow into a cancer, since isolated from the others it is ‘very harsh and malignant’.¹⁸¹ So this black bile, even though it is a normal part of our constitution, is, indeed, potentially extremely dangerous. We previously noticed that, in HNH, an imbalance of the humours is the cause of disease. What we learn from At. Bil. about the black bile that is like the sediment of blood seems to be congruent with that theory. It is notable, however, just how extremely detrimental the black bile can become when it is in excess or isolation. Also, there seem to be no particularly beneficial aspects to this black bile, even though it is considered a normal part of our constitution.¹⁸² The general impression we get of this substance in At. Bil. is that of something very dangerous and detrimental that should be managed carefully by experts when it manifests itself, and that seems to have absolutely no beneficial qualities or purpose in itself. This corresponds to the notion of black bile as a potentially dangerous residue that we have found both in the Peripatetic tradition and in Rufus. It is also at least congruent with the humoural theory of HNH, since that also does not mention any particular beneficial aspect of black bile, while it does, on the other hand, presents the aforementioned notion of disease as a consequence of imbalance or isolation of any particular humour. Indeed, Galen also cites from the Hippocratic On the Nature of Man in his description of the black bile that is like a sediment of the blood. He quotes the passage that states that health is achieved through a balance of the humours, while excess, lack or isolation of one particular humour causes pain and disease. Besides melancholy, excess or isolation of black bile can apparently cause cancer, ulcers, elephantiasis, phrenitis, varicoceles and haemorrhoids.¹⁸³ Clearly, Galen is implying that these diseases are the consequence of a humoural imbalance in terms of an excess or isolation of the black bile that is discussed in HNH.

Still, despite all of its potential danger, Galen simply considers this black bile a necessary part of our body that is particularly related to digestion and the transformation of food into blood.¹⁸⁴ Nature does its best to deal with this substance in the human body, in order to preserve life, but that seems to entail only getting rid of it as much as possible. This sediment is a normal part of our constitution as long as it is regularly evacuated.¹⁸⁵ Our body gets rid of black bile through evacuation, sometimes even forcing excess black bile towards the surface of the body in an attempt to get it out, which can cause the skin to thicken and dry. As we saw before, thickness and dryness are qualities peculiar to black bile in the humoural theory of HNH as well. Likewise, the doctor’s main concern seems to be for evacuation of the black bile, as well as for the development of a diet that produces better humours, which was also the main approach in Rufus’ writings.¹⁸⁶ However, it is not possible, according to Galen, to completely get rid of black bile; its production is necessary.¹⁸⁷ What is possible, though, is to make sure that as little as possible of it is produced by regulating diet, since it is through processing food and drink that we obtain black bile in the first place.¹⁸⁸

It is interesting that Galen brings up the impossibility of the complete absence of black bile in this manner, and then suggests reducing production of it. There have been predecessors, notably Erasistratus, who, according to Galen, did not consider black bile at all. Galen finds fault with them, obviously, but seems to agree that a complete absence of black bile appears like an appealing idea, given the description he just provided of its detrimental effects. We shall return to this suggestion later. In any case, there are also limits to the extent that the production of black bile can be regulated. Besides diet, people’s specific constitution, the season, climate, and, notably, one’s mental state, all have an influence on it. Interestingly, people with a hotter and drier mixture (θερμότερα καὶ ξηρότερα ταῖς κράσεσίν) are more prone to produce black bile. Also, production goes up in hotter and drier times of the year. This fits with the connection of black bile to autumn that was made in On the Nature of Man, since autumn comes right after summer, the season that is hot and dry and that, thus, increases the amount of black bile, which would make the season immediately following summer the period in which black bile is most abundant. Finally, hotter and drier places also increase the production of black bile, as do dry foods that consist of thick particles.¹⁸⁹ Clearly, the elemental qualities of hotness and dryness, and their predominance, are related to the production and possible excess of black bile in At. Bil. This might seem remarkable, since, as has been pointed out by Jouanna, in other Galenic works it is rather the qualities of coldness and dryness that are ascribed to the black bile.¹⁹⁰ However, there is no need to posit inconsistencies here. We simply have to note that the quality of hotness is associated with the production of black bile, while that of coldness is used to describe the state of black bile itself. Black bile is a substance that is cold and dry because it was formerly very hot, lost all of its moisture because of that hotness, and then cooled down. It is abundant in autumn because it is a remnant of summer. As we saw before, Rufus compares it with pieces of coal that have cooled down.¹⁹¹ Galen does not attribute the quality of hotness to the black bile itself, but rather attributes the quality of being burned to it, which already involves a receding of the hotness, leaving a remnant that cooled down to some extent or other. This comes to the fore clearly in the following passage from On the Causes of Symptoms (Caus. Symp.):

τοὐναντίον γὰρ ἅπαν ἐξ ὑπεροπτησεώς τε καὶ ζέσεως, οἷον τέφρα τις ἡ μέλαινα χολὴ συνίσταται ψυχρὰ μὲν, ὅτι γεώδης, θερμότητος δὲ μετέχουσα, καθάπερ ἡ τέφρα τε καὶ τὸ ὄξος.¹⁹²

On the contrary, black bile like ash arises entirely from overheating and boiling. It is cold in that it is earth-like, but partakes of heat just as do ash and vinegar.

tr. Johnston

Like ashes, black bile comes to be as a result of the overheating of something that then subsequently cools down.¹⁹³ This is how Galen also defines the black bile in HNH, as Jouanna points out as well:

ἐγένετο δ΄ εἰκότως τοιοῦτος διὰ τὸ προατωπτῆσθαι τοὺς χυμοὺς τῷ θέρει. τὸ δ΄ ὑπόλειμμα τῶν ὀπτηθέντων, ὅταν δηλονότι σβεσθῇ τὸ θερμόν, αὐτίκα γίνεται ψυχρόν τε καὶ ξηρόν, ψυχρὸν μὲν διὰ τὴν τοῦ θερμοῦ σβέσιν, ξηρὸν δέ, ὅτι κατὰ τὴν ὄπτησιν ἐξεδαπανήθη πᾶν τὸ ὑγρὸν ἐξ αὐτοῦ.¹⁹⁴

And it is reasonable that such a humour arises as a result of the cooking of the humours during the summer. The residue of this cooking, when the hot has been thoroughly quenched, then becomes both cold and dry, cold as a result of the quenching of the heat, dry because the process of cooking drives out all of the moisture from it.

tr. Hankinson

Both of these passages are reminiscent of the metaphor of the coals, and show that the qualities of black bile are not just to be cold and dry by itself, but rather to be cold and dry as the consequence of a previous heating that has now receded. This is brought to the fore even more clearly in a passage from On Mixtures (Temp.):

εἰ γὰρ τις εὐθὺς ἐξ ἀρχῆς ἐγένετο τῇ κράσει ψυχρότερός τε καὶ ξηρότερος, οὐ μελαγχολικὸς ὁ τοιοῦτος, ἀλλὰ φλεγματικός ἐστι τοῖς περιττώμασιν. εἰ δ΄ ἐκ μεταπτώσεως ἐγένετο ψυχρὸς καὶ ξηρός, ἐξ ἀνάγκης ὁ τοιοῦτος εὐθὺς ἤδη καὶ μελαγχολικός ἐστιν, οἷον εἴ τις ἔμπροσθεν ὑπάρχων θερμὸς καὶ ξηρὸς ἐκ συγκαύσεως τοῦ αἵματος πλείστην ἐγέννησε τὴν μέλαιναν χολήν. οὗτος γὰρ ἐστιν ὁ πρὸς τῷ ξηρὸς εἶναι καὶ ψυχρὸς εὐθὺς καὶ μελαγχολικὸς ὑπάρχων. εἰ δ΄ απ΄ ἀρχῆς εἴη ψυχρὸς καὶ ξηρός, ἡ μὲν ἕξις τοῦ σώματος τούτῳ λευκὴ καὶ μαλακὴ καὶ ψιλὴ τριχῶν, ἄφλεβος δὲ καὶ ἄναρθρος καὶ ἰσχνὴ καὴ ἀπτομένοις ψυχρὰ καὶ τὸ τῆς ψυχῆς ἦθος ἄτολμον καὶ δειλὸν καὶ δύσθυμον, οὐ μὴν μελαγχολικά γε τὰ περιττώματα.¹⁹⁵

Someone who became relatively cold and dry in his mixture right from the beginning will not be melancholic, but phlegmatic, in his residues. On the other hand, someone who has become cold and dry through some change will of necessity be automatically also melancholic. This is the case, for example, with a previously hot and dry person, who has produced a very large quantity of black bile from the burning of the blood: such a person combines being dry and cold with, at the very same time, being melancholic. The bodily condition of one who was cold and dry from the beginning will be white, soft, devoid of hair, lacking in veins and in articulation, thin and cold to the touch, while the character of his soul will be lacking in resolve, cowardly, easily dispirited. Yet his residues will not be melancholic.

tr. Singer and van der Eijk

The same notion is also found in The Art of Medicine, with emphasis on the stage of life rather than the season. There, Galen remarks that when a mixture that is dry and hot changes after the prime of life into one that is dry and cold, it will have become melancholic.¹⁹⁶ This is completely in line with the description of the transition between summer and autumn, and both passages show, in accordance with the descriptions from HNH and Caus. Symp., that black bile is not merely dry and cold of itself but rather a remnant of excessive heat that has cooled down.

Jouanna restricts his discussion more to HNH, and regards the passage from HNH quoted above as establishing a bridge between two different notions of black bile in Nat. Fac. and At. Bil., which associate it with coldness and hotness respectively.¹⁹⁷ In this manner, as Jouanna argues, Galen reconciles the theory of black bile as a result of the burning of other humours, particularly yellow bile, with the previous Hippocratic theory on black bile that did not consider it as the result of an alteration of another humour. Jouanna follows this distinction, as we find it in Galen, back through Rufus and the Hippocratic corpus.¹⁹⁸ Thus, Galen seems to connect the different kinds of black bile distinguished by Rufus: the sediment-like black bile that is related to digestion becomes associated with the quality of being burnt that was reserved for the other kind of black bile. This makes sense, since digestion is a process that involves heating. Again, by this association Galen normalizes the production of black bile and obscures the difference between normal and dangerous versions of it.¹⁹⁹ While I generally agree with Jouanna’s interpretation – even though I would also note that the connective function that he attributes to HNH is more broadly attested in Galen’s work, as we have seen – there is one aspect of it that I find confusing. This is his distinction between a black bile that is ‘innée’, innate, and one that is not. In his view, the black bile of the Hippocratic On the Nature of Man should be innate, as opposed to the black bile that is a result of the burning of another humour. I find this a somewhat confusing perspective, since all the humours, including blood, are always already the result of a productive process within the body. At the same time, we always have these humours in our body, already from when we are still an embryo, before we are actually born. To give an example: I see no reason why an embryo, from Galen’s perspective, could not have the kind of black bile that is the result of burning, if, for example, its mother has this kind in her body. Then, when the baby is born, is this humour innate to it but not to another baby? It does not make sense to me, therefore, to primarily distinguish the different kinds of black biles in Galen as either innate or not innate. Both are produced, even though one is more of an aberration than the other. It seems to me rather that, for Galen, black bile is a necessary part of our constitution in as far as digestion is, as a necessary by-product of it. As such, it can be present in the body either in a way that is according to nature or in a way that is unnatural and causes disease, as becomes clear from HNH, Nat. Fac. and At. Bil. alike. Whether it is present in a normal or a harmful way, can depend on several circumstances: it is harmful when it is present in excess or isolation (i.e. unmixed) in various parts of the body or when it is the result of a severe heating. Likewise, Stewart also distinguishes between what he calls an ‘ideal natural black bile’, which he also calls ‘innate’, a ‘non-ideal natural black bile’, and an ‘altered black bile’.²⁰⁰ The latter is the dangerous black bile that is the remnant of overheating of (other) humours. The distinction between the former two kinds, however, is a distinction that Stewart introduces between the black bile that we find in HNH, and the black bile that is described as a sediment of the blood and that is associated with digestion, as we find it in At. Bil. and Nat. Fac., among other works. This distinction seems to me to be Stewart’s own fabrication and to be without basis in Galen’s texts. It seems to rest on the assumption that the black bile of HNH should be beneficial, for which I have not found textual warrant.²⁰¹ The only passage that Stewart cites to justify the distinction between these two is actually from Loc. Aff. and will be discussed in the next paragraph, in which we shall discuss the harmful variation of black bile that is either the result of overheating, excess or isolation. We shall find that in Loc. Aff. too, Galen distinguishes between two kinds of black bile. One is normal (though potentially always harmful) and the other is extremely harmful. The latter is, in fact, the only variation that can be called black bile in a strict sense according to Galen, as we saw before. The former can function as a normal part of our constitution and is potentially harmful, as we have just discussed, when it is present in excessive amount or when it is isolated.

2.4 The Normal and the Harmful III: the Harmful That Used to Be Normal

Let us look at the relevant passage from Loc. Aff. It is quite long, so I shall cite it in parts. Galen starts with making a distinction between different kinds of black bile or melancholic humour, as he did just before this passage with different kinds of phlegm:

ὡσαύτως δὲ καὶ ὁ μελαγχολικὸς χυμὸς ἐν τῇ συστάσει σαφεῖς ἔχει τὰς διαφορὰς, ὁ μὲν οἷον τρὺξ αἵματος, ἐναργῶς φαινόμενος ἱκανῶς παχὺς, ὥσπερ ἡ τοῦ οἴνου τρύξ· ὁ δὲ πολλῷ μὲν τούτου λεπτότερος κατὰ τὴν σύστασιν, ὀξὺς δὲ καὶ τοῖς ἐμέσασιν αὐτὸν φαινόμενος καὶ τοἶς ὀσμωμένοις· οὗτος καὶ ξύει τὴν γῆν, ἐξαίρων τε καὶ ζυμῶν καὶ πομφόλυγας ἐγείρων, οἷαι τοῖς ζέουσι ζωμοῖς ἐφίστανται.²⁰²

In the same manner also the melancholic humour has clear differences in its composition, one kind being like the sediment of blood, clearly appearing very thick, just like the lees of wine; the other is much finer in composition than that, and it appears acidic both to those that vomit it as well as to those who smell it; this one also corrodes the earth, raising it up and causing it to effervesce and arousing bubbles, as those that surface in boiling soups.

Galen here distinguishes between two kinds of melancholic humour, a distinction that corresponds to the one we found in At. Bil. The first is the one that is like the sediment of blood, the second is a much more acidic and dangerous one. At the beginning of the discussion of black bile in At. Bil. he makes the same distinction between the acidity manifesting itself only to the person that vomits or to the bystanders as well.²⁰³ There, Galen distinguishes black bile in the strict sense (τὸν τῆς ἀκριβοῦς μελαίνης χολῆς χυμὸν) from the one that is like the sediment in the blood. Only the acidity of the black bile in the strict sense, the one that is extremely harmful and has a corroding effect on the earth, is not only perceived by the person vomiting it up but also by the bystanders, through smell. Galen now proceeds to further specify the black bile that is like a sediment of the blood, and remarks that this is not black bile in a strict sense, as he also did in At. Bil.:

ὅν δ΄ ἔφην ἐοικέναι παχείᾳ τρυγὶ, τήν τε ζύμωσιν οὐκ ἐργάζεται κατὰ τῆς γῆς ἐκχυθεὶς, πλὴν εἰ μὴ πάνυ σφόδρα τύχοι τότε κατοπτηθεὶς ἐν διακαεῖ πυρετῷ, καὶ ἥκιστα μετέχει ποιότητος ὀξείας, ἡνίκα καὶ καλεῖν αὐτὸν εἴωθα μελαγχολικὸν χυμὸν ἢ μελαγχολικὸν αἷμα, μέλαιναν γὰρ χολὴν οὐδέπω δικαιῶ τὸν τοιοῦτον ὀνομάζειν.²⁰⁴

The one which I said resembles thick sediment, does not produce the fermentation when it is poured out over the earth, unless it happens to have been burnt very intensely during a state of burning fever, and it only has very little share in the quality of acidity. Hence I’m used to calling it melancholic humour or melancholic blood, for I think that is not yet proper to call it black bile.

tr. Van der Eijk

Apparently, both of these kinds of black bile possess the quality of acidity to some extent, but the one that is like a sediment of the blood possesses only very little of it, which renders it much less dangerous. However, it can become much more acidic when it is excessively heated due to a fever. Here, again, we see that we have to be careful to apply all too neatly developed distinctions on the different kinds of black bile that Galen discusses. The one that is like a thick sediment is a normal part of our constitution, unlike the one that is the result of an overheating of yellow bile, but it can become extremely harmful as well, when combined with fever, for example. Nonetheless, Galen does not consider it black bile in the strict sense and, therefore, as he says, also calls it melancholic humour or melancholic blood. But at the outset of this passage, as we have seen, he called both of these kinds of black bile ‘melancholic humour’. What are we to make of this? Stewart sees Galen making a distinction between three different types of black bile here, one of which is the ‘innate’ black bile that Stewart considers as the only one that is properly speaking black bile – despite the contradiction that would generate with At. Bil. and other works, apparently, where it is only the acidic and malignant black bile that is properly speaking black bile – while the other two are the two defined above, which would then both be melancholic humours.²⁰⁵ However, in Stewart’s reading, both of the two ‘melancholic humours’ would then not, properly speaking, be black bile, while it is clear from the text as cited and discussed above that Galen only says of the sediment-like black bile that it is not strictly speaking black bile, implying much rather that the highly acidic version is strictly speaking black bile. This also corresponds to the distinction between the two kinds of black bile as we find it in At. Bil. and elsewhere.²⁰⁶ Stewart’s reading is not tenable in this light. How, then, are we to make sense of the fact that Galen first calls both of these types ‘melancholic humours’, and then says that only one of them is strictly speaking black bile, while the other one can be called a ‘melancholic humour’? To solve this problem, we can have another look at At. Bil., where Galen makes the same distinction at the very end of the treatise:

καὶ μέντοι καὶ παρὰ τὴν ὁμωνυμίαν ἑαυτοὺς, οὐ γὰρ ἡμᾶς γε, σοφίζονται, τὸν μελαγχολικὸν χυμὸν, ὅν ἐν τοῖς ὑγιαίνουσι γεννᾶσθαί φαμεν, ἀκούοντες ἀεὶ κατὰ τῆς μελαίνης λέγεσθαι χολῆς, ἥν ἐν τῷ παρὰ φύσιν ἔχειν γεννᾶσθαί φαμεν. oὐ γὰρ ἡ αὐτὴ κατά γε τοὺς ἀκριβως ὑγιαίνοντάς ἐστι μέλαινα χολὴ, καὶ τινας τῶν παρὰ φύσιν ἐχόντων, ἀμφοτέρας δὲ μελαγχολικὸν χυμὸν ὀνομάζειν οὐδὲν κωλύει.²⁰⁷

And through homonymy they play tricks on themselves, but not on me, with regard to the melancholic humour, which we say is produced in the healthy, since they always understand what is said in relation to the black bile, which we say is produced in those that are in an unnatural state. For it is not the same black bile in those who are perfectly healthy and in some of those who are in an unnatural state, but nothing prevents us from naming both of them melancholic humour.

tr. Grant, modified

Here we find, first of all, the same basic distinction: the melancholic humour is also part of a healthy constitution, whereas black bile is produced in an unnatural state – the former is normal and the latter is harmful. But then, in the very next sentence, Galen simply proceeds to call both of them black bile: ‘it is not the same black bile’ in both of these types. What is more, he continues even to state that nothing prevents him from calling both ‘melancholic humour’! Thus, what we find is that, strictly speaking, the sediment-like kind of black bile should be called a melancholic humour and the highly acidic harmful black bile that is the result of the burning of yellow bile (or sometimes another humour²⁰⁸) should be called black bile proper.²⁰⁹ At the same time, however, both can be called black bile and both can be called melancholic humour according to Galen, and he even says explicitly that there is no need to get hung up on these names. The reason for this, I propose, is that even though it is certainly important to distinguish between the two, especially with regard to therapeutic practice (as we notice in At. Bil.), there are also important similarities between the two. We have already noticed above that the normal black bile, the sediment-like kind, is potentially harmful. In the next sentences from Loc. Aff., following the previous quotation above, this is affirmed:

γεννᾶται δ΄ ὁ χυμὸς οὗτος ἐνίοις πολὺς, ἢ διὰ τὴν ἐξ ἀρχῆς κρᾶσιν, ἢ δι΄ ἔθος ἐδεσμάτων εἰς τοιοῦτον χυμὸν ἐν τῇ κατὰ τὰς φλέβας πέψει μεταβαλόντων. ὥσπερ δ΄ ὁ παχὺς χυμὸς τοῦ φλέγματος, οὕτω καὶ οὗτος παχὺς χυμὸς ὁ μελαγχολικὸς ἐπιληψίας ποτ΄ ἐργάζεται κατὰ τὰς ἐκροὰς τῶν ἐν ἐγκεφάλῳ κοιλιῶν ἰσχόμενος, ἤτοι τῆς μέσης, ἢ τῆς ὄπισθεν· ὅτ΄ ἂν δ΄ ἐν αὐτῷ πλεονάσῃ τῷ τοῦ ἐγκεφάλου σώματι, μελαγχολίαν ἐργάζεται, καθάπερ ὁ ἕτερος χυμὸς τῆς μελαίνης χολῆς, ὁ κατωπτημένης τῆς ξανθῆς χολῆς γενόμενος, τὰς θηριώδεις παραφροσύνας ἀποτελεῖ χωρὶς πυρετοῦ τε καὶ σὺν πυρετῷ, πλεονάζων ἐν τῷ σώματι τοῦ ἐγκεφάλου.²¹⁰

For that humour is generated in some people in large quantity either as a result of their initial mixture or by a habit of eating foods that changes into this during the digestion within the blood vessels. Just like the thick phlegmatic humour, this thick melancholic humour likewise sometimes causes instances of epilepsy, because it is contained in the places where the cavities of the brain, whether the middle or the posterior cavity, have their exit channels. But when it is present in excess in the very body of the brain, it causes melancholy, just as the other kind of humour of black bile, the one that has arisen as a result of the burning of yellow bile, results in violent deliria, both without fever and with fever, when it fills the brain excessively.

tr. Van der Eijk, modified

In the first sentence of this quotation we recognize the distinction we found in Rufus previously, but here it is applied to the sediment-like black bile, of which some people, apparently, naturally have a higher quantity, whereas others have increased its quantity through overheating of particular food-substances in the blood vessels.²¹¹ Presumably, in more excessive quantity, it becomes more harmful. It can also become harmful when it obstructs ventricles, or when it abounds in the brain itself. In the latter case, it can even act as the same kind of cause as the harmful, highly acidic black bile that is the result of the burning of yellow bile. Thus, what is striking here, is that while Galen clearly distinguishes these two types of black bile, both are at least potentially harmful and can cause melancholy. The normal, sediment-like form can do so in particular circumstances, and the residue of the burning of yellow bile seems to do so without further qualification.

In the following passage from Nat. Fac. we find the same distinction between the normal and the harmful kinds of black bile, again phrased as being in accordance with or against nature respectively:

καὶ μοι δοκοῦσιν οἱ πλεῖστοι τῶν παλαιῶν ἰατρῶν αὐτὸ μὲν τ`κατὰ φύσιν ἔχον τοῦ τοιότου χυμοῦ καὶ διαχωροῦν κάτω καὶ πολλάκις ἐπιπολάζον ἄνω μέλανα καλεῖν χυμόν, οὐ μέλαιναν χολήν, τὸ δ΄ ἐκ συγκαύσεώς τινος καὶ σηπεδόνος εἰς τὴν ὀξεῖαν μεθιστάμενον ποιότητα μέλαιναν ὀνομάζειν χολήν. ἀλλὰ περὶ μὲν τῶν ὀνομάτων οὐ χρὴ διαφέρεσθαι, τὸ δ΄ ἀληθὲς ὧδ΄ ἔχον εἰδέναι.²¹²

It seems to me also that most of the ancient physicians call ‘melancholic humour’ the portion which we have naturally of this humour and which is discharged from the bowel and frequently rises up to the surface as well; but they call ‘black bile’ that which has been altered into a more acidic quality through a kind of burning and putrefaction. There is no need, however, to dispute about names, but we must realise the facts, which are as follows.

tr. Brock, modified

Here, Galen projects his distinction between black bile in a strict sense – the harmful acidic one that is the result of a burning of humours – and black bile in a loose sense that is rather a melancholic humour – the one that is a normal consequence of the natural processes of digestion – unto the work of his predecessors, as he does more often.²¹³ Again, he emphasizes that it is not so important to be precise about these names. After this passage he uses the property of causing the earth to effervesce again as a criterion for distinguishing the black bile in a strict sense, which is unnatural, from the melancholic humour, which is natural.

It is noteworthy that, in the passage from Loc. Aff., Galen distinguishes the two by saying that the melancholic humour that is in accordance with nature has not yet (οὐδέπω) undergone the burning process that causes it to become highly acid. He repeatedly formulates the difference in this manner:

ὥσπερ γε καὶ τοῦ μέλανος χυμοῦ τὸ μὲν μήπω τὴν οἷον ζέσιν τε καὶ ζύμωσιν τῆς γῆς ἐργαζόμενον κατὰ φύσιν ἐστί, τὸ δ΄ εἰς τοιαύτην μεθιστάμενον ἰδέαν τε καὶ δύναμιν ἤδη παρὰ φύσιν, ὡς ἂν τὴν ἐκ τῆς συγκαύσεως τοῦ παρὰ φύσιν θερμοῦ προσειληφὸς δριμύτητα καὶ οἷον τέφρα τις ἤδη γεγονός ὧδέ πως καὶ ἡ κεκαυμένη τρὺξ τῆς ἀκαύστου διήνεγκε. θερμὸν γὰρ τι χρῆμα αὕτη γ΄ ἱκανῶς ἐστιν, ὥστε καίειν τε καὶ τήκειν καὶ διαφθείρειν τὴν σάρκα. τῇ δ΄ ἑτέρᾳ τῇ μήπω κεκαυμένῃ …²¹⁴

Similarly with the black humour: that which does not yet produce this cooking and fermentation of the ground, is natural, while that which has been altered towards such an appearance and capacity, is already unnatural, as it has taken on an acidic character from the burning by unnatural heat and has already become transformed into ashes, as it were, in the same manner as lees that have been burned differ from unburned ones. For the former is a warm substance, able to burn, dissolve, and destroy the flesh. The other kind, which has not yet undergone burning …

tr. Brock, modified

Here we see that it is the normal, natural black bile (that should strictly be called ‘melancholic humour’) itself that can become the acidic, detrimental and unnatural black bile.²¹⁵ The two kinds of black bile are closely related: the one can transform into the other. The harmful black bile that is here called unnatural, previously was a natural melancholic humour. It does not need to be black bile that is burned, but it can also be the yellow bile, as Galen adds right after the passage just quoted, and as we have seen before.

It appears that what Galen calls black bile in the strict sense is a degeneration of a humour (mostly yellow bile, but also black bile and blood²¹⁶) that is in itself a normal part of a healthy constitution. At the same time, though, not all the humours are equally a normal part of our constitution. Even the normal black bile is described by Galen as a necessary by-product of digestion that is potentially dangerous and the production of which should be carefully managed and ideally reduced.²¹⁷ Galen may have attempted to reconcile the Hippocratic notion of black bile as one of the four humours that constitute our nature with the Aristotelian notion of black bile as a residue, resulting in a theory of black bile that is a necessary by-product of our digestive system and that is, as such, a normal part of our constitution as long as it is properly managed. For this management, we are equipped by nature with an organ to dispose of black bile: the spleen. In the next paragraph, we shall discuss the role of the spleen, which shall shed more light on the role of black bile in the human body in Galen.

2.5 Spleen

As Galen seems to suggest in At. Bil., it might perhaps have been better if there were no need for us to produce black bile, but there is.²¹⁸ Given our nature as mortal beings subject to continuous change, it is necessary for us to consume food and drink, which we need to digest and transform into blood, a by-product of which process is black bile. It is not uncommon for Galen to dwell on this necessity. In his commentary on the Timaeus, he notes that the gods made plants as nourishment for us since we would otherwise, given our elemental constitution, disperse our substance without sufficient restoration being possible.²¹⁹ That is to say, the need for digestion, as such, is the direct result of an initially imperfect balance in our body. This is important to realize in our evaluation of black bile and the question of its usefulness. Perhaps black bile can to a certain extent be useful to thicken blood that would otherwise be too thin. It is, after all, the thickest of the humours. Some of it, upon thorough alteration by the spleen, can be useful as a nutriment for the spleen itself. Some of it, again upon alteration by the spleen, is disposed in the stomach, and can be beneficial to the stomach by tightening it and drawing it together so that it holds the food closer, which is good for digestion.²²⁰ Other than these functions, that already depend on the alteration by the spleen, I see no positive function of the stuff in Galen. In any case, the proper thickness of blood could have presumably been effected in another manner than adding a dark substance which one then needs to get rid of as much as possible, and which has horrible side-effects in various circumstances. The nourishment for the spleen itself is only necessary because the spleen is necessary, which is in turn only necessary for the breaking down of black bile in the first place. How, then, can the presence of black bile in the human constitution be reconciled with Galen’s teleological framework, in which nature, that wise artisan, excels in making finely attuned products such as ourselves?

The answer has already been given: nature also gave us the spleen so that we can get rid of the black bile, instead of letting that pernicious substance wander around in our bodies:

ηὐξαμην οὖν κἀνταῦθ΄ ἐρωτῆσαι δύνασθαι τὸν ᾿Ερασίστρατον, εἰ μηδὲν ὄργανον ἡ τεχνικὴ φύσις ἐδημιούργησε καθαρτικὸν τοῦ τοιούτου χυμοῦ, ἀλλὰ τῶν μὲν οὔρων ἄρα τῆς διακρίσεώς ἐστιν ὄργανα δύο καὶ τῆς ξανθῆς χολῆς ἕτερον οὐ σμικρόν, ὁ δὲ τούτων κακοηθέστερος χυμὸς ἀλᾶται διὰ παντὸς ἐν ταῖς φλεψὶν ἀναμεμιγμένος τῷ αἵματι.²²¹

At this point, also, I would gladly have been able to ask Erasistratus whether his artistic nature has not constructed any organ for clearing away a humour such as this. For whilst there are two organs for the excretion of urine, and another of considerable size for that of yellow bile, does the humour which is more pernicious than these wander about persistently in the veins mingled with the blood?

tr. Brock

Notice that Galen calls black bile a more pernicious humour than the others, while the subject is simply the normal black bile that is routinely separated out by the liver and then distributed to the spleen, as opposed to the highly acidic black bile that is the result of excessive burning and that is fatal. This pernicious substance comes to be as a kind of by-product or remnant of the normal digestive process of the liver, which transforms food into blood, and is then processed by the spleen. The black bile undergoes a long process of alteration in the spleen, which is powered by a flow of innate heat from the heart. In this process, some of it is changed into something else, namely a kind of thin, dark blood that can serve as nutriment for the spleen itself. The rest of it is discharged into the stomach, where it is normally not harmful, and is, again, even beneficial for digestion by virtue of its capacity for drawing the stomach together.

If the spleen functions properly, the dangers of black bile are averted: most of the black bile is altered and subsequently separated off, and it seems that perhaps, indeed, a small quantity, which also needs to be most moderate in quality, can be useful to give the blood sufficient thickness:

τῶν δ΄ εἰρημένων χυμῶν ἐστί τις χρεία τῇ φύσει καὶ τοῦ παχέος καὶ τοῦ λεπτοῦ καὶ καθαίρεται πρός τε τοῦ σπληνὸς καὶ τῆς ἐπὶ τῷ ἥπατι κύστεως τὸ αἷμα καὶ ἀποτίθεται τοσοῦτον τε καὶ τοιοῦτον ἑκατέρου μέρος, ὅσον καὶ οἷον, εἴπερ εἰς ὅλον ἠνέχθη τοῦ ζῴου τὸ σῶμα, βλάβηην ἄν τιν΄ εἰργάσατο. τὸ γὰρ ἱκανῶς παχὺ καὶ γεῶδες καὶ τελέως διαπεφευγὸς τὴν ἐν τῷ ἥπατι μεταβολὴν ὁ σπλὴν εἰς ἑαυτὸν ἕλκει· τὸ δ΄ ἄλλο τὸ μετρίως παχὺ σὺν τῷ κατειργάσθαι πάντη φέρεται. δεῖται γὰρ ἐν πολλοῖς τοῦ ζῴου μορίοις παχύτητός τινος τὸ αἷμα καθάπερ οἴμαι καὶ τῶν ἐμφερομένων ἰνῶν.²²²

There is, however, a natural use for the humours first mentioned, both thick and thin; the blood is purified both by the spleen and by the bladder beside the liver, and a part of each of the two humours is put away, of such quantity and quality that, if it were carried all over the body, it would do a certain amount of harm. For that which is decidedly thick and earthy in nature, and has entirely escaped alteration in the liver, is drawn by the spleen into itself; the other part which is only moderately thick, after being elaborated [in the liver], is carried all over the body. For the blood in many parts of the body has need of a certain amount of thickening, as also, I take it, of the fibres which it contains.

tr. Brock

This passage seems to imply that we can use a small amount of the more moderate parts of the black bile, in order to provide certain parts of the body with the proper degree of solidity.²²³ It seems that the black bile, though pernicious in nature, can also be useful as long as it is adequately managed by the spleen. That is to say, as long as the bulk of it is separated off and evacuated, and the mildest bits are used for a moderate thickening of the blood.

The spleen has an especially apt composition for drawing black bile into itself, as becomes clear from UP, and as we would expect of the wise artisan that Galen believes nature to be.²²⁴ The spleen is particularly porous and has a loose texture, like a sponge, so that it can attract and take into itself the thickness of the black bile. The part that does this is called the parenchyma (παρέγχυμα), a name that Galen seems to have taken over from Erasistratus. It is full of large arteries that break up and alter the thick melancholic humour by virtue of their incessant motion (which is opposed to the static nature of the black bile itself, as we shall see) and a strong innate heat that comes down from the heart.²²⁵ Some of these compositional characteristics are also found in Plato’s description of the spleen in the Timaeus. There, Timaeus describes the spleen as an organ of loose texture constructed out of hollow and bloodless material, which takes into itself the impurities and cleanses them, while, in turn, it also needs to be cleansed itself, since it will otherwise grow out of proportion.²²⁶ The description is quite similar to Galen’s in terms of general function and constitution, but in Plato the kind of stuff that is attracted by the spleen is less specific and is certainly not defined as the dark bilious residue of digestion. But, as we have noticed, the spleen is associated with black bile and melancholy in Rufus. Galen knew both Rufus and Plato, of course, and it might have been logical for him to combine both of these descriptions. Its sponge-like nature could cause the spleen to grow when it takes in much residue, both in Plato and Galen, which in turn can again be counteracted, according to Galen, by a so-called ‘thinning diet’. This diet is supposed to help against enlargement of the spleen and hardening of the liver, that is to say, it is supposed to reduce the production of black bile in the body.²²⁷ Diet logically plays an important role in the production of black bile, since it is through processing food that we produce the stuff in the first place – this is a theme that we have also found in Rufus before. Thus, Galen also distinguishes between excess of black bile that is the result of weakness of the capacity of the spleen (see below) and excess that is the result of an abnormal diet.²²⁸ In normal circumstances, the spleen deals with the consequences of the necessary intake of food that produces black bile. But this normal situation is relatively precarious: when the spleen does not function well, or when our diet is such that we put too much burden on it, there will be an excess of the pernicious substance. With regard to the composition of the spleen itself, we also find a similar notion of the basic composition of the spleen in the Hippocratic Ancient Medicine, where the structure of the spleen is described as spongy (σπογγοειδέα) and porous (ἀραιά), which makes it suitable for drawing in fluids.²²⁹ With regard to other possible precedents and antagonists for Galen’s depiction of the role of the spleen, Stewart has provided an extensive and useful overview.²³⁰

As we noticed, thankfully, nature in all her wisdom has equipped the spleen with the proper constitution for neutralizing the dangerous potential of black bile, given the fact that she could not have entirely prevented its production. As soon as the spleen does not function properly, however, there is disaster in the making:

ἐπεὶ δὴ τὴν ἐνέργειαν ἔχει φύσει, τὸ μελαγχολικὸν ἐκ τοῦ ἥπατος ἕλκειν αἷμα εἰς ἑαυτὸν, τούτῳ γὰρ ἐδείχθη τρεφόμενος, τῆς οὖν ἑλκτικῆς αὐτοῦ δυνάμεως ἀτόνου γενομένης, ἀκάθαρτον εἰς ὅλον τὸ σῶμα φέρεται τὸ ἐξ ἥπατος αἷμα, καὶ κατὰ τοῦτο μελάντερον αὐτοῖς γίνεται τὸ χρῶμα.²³¹

Since [the spleen] indeed by nature has the function to draw the melancholic blood from the liver to itself – for it has been shown that it is nourished by that melancholic blood – the blood from the liver is borne through the entire body uncleansed when this attractive power has come to be weak, and for that reason the colour of those people becomes darker.

If the spleen fails, the blood maintains the level of black bile that it had after its production by the liver, and carries this black bile through the entire body, causing the whole body to become darker.²³² The process of digestion produces a substance that subsequently needs to be neutralized because its darkness will otherwise dominate the entire body. This neutralization is essentially the function of the spleen.²³³ Stewart interprets the quoted passage in a different manner and translates the part after the first comma as ‘blood draws the melancholic humour from the liver to itself, for it was shown that it receives its nourishment by this humour’.²³⁴ The idea that blood (rather than the spleen) draws the black bile to itself and is nourished by it seems to fit Stewart’s notion of an essentially beneficial kind of black bile, as one of the three types he distinguishes. As an interpretation of this text it does not seem tenable, though. First of all, the blood itself is also produced in the liver and is actually containing the black bile already. Second, the context here is clearly a description of the natural function of the spleen, for which we also have many parallels, some of which we discuss in this paragraph. Finally, there are other places in which Galen unambiguously states that it is the spleen itself that is nourished by the black bile (that is to say, after the black bile has undergone a certain transformation through being processed by the spleen).²³⁵

In At. Bil., Galen also stated that the whole body becomes darker when the spleen is diseased. According to Galen, the greatest doctors and philosophers have therefore held that the liver is cleansed by the spleen, drawing into itself that residual part of the blood that is comparable to the lees of wine.²³⁶ Interestingly, in these passages Galen presents us with an empirical basis for his conception of the function of the spleen, namely, that we become darker all over our body when the spleen is not functioning properly. The darkness of the black bile then becomes predominant and also manifests itself on the outside. In Nat. Fac., too, the spleen is said to draw the melancholic humour to itself when it is properly functioning; when it is weak, the blood will become thicker and darker because it has not been cleansed of black bile well enough, which again causes the whole body to take on a darker colour.²³⁷ In this particular passage, both yellow and black bile are depicted as residues (περιττώματα). They are natural results of the alteration that our innate heat effects on the foodstuff that we consume, and need to subsequently be broken down by the gall bladder and spleen respectively:

οἶνον δή μοι νόει γλεύκινον οὐ πρὸ πολλοῦ τῶν σταφυλῶν ἐκτεθλιμμένον ζέοντά τε καὶ ἀλλοιούμενον ὑπὸ τῆς ἐν αὐτῷ θερμασίας· ἔπειτα κατὰ τὴν αὐτοῦ μεταβολὴν δύο γεννώμενα περιττώματα τὸ μὲν κουφότερόν τε καὶ ἀερωδέστερον, τὸ δὲ βαρύτερόν τε καὶ γεωδέστερον, ὧν τὸ μὲν ἄνθος, οἶμαι, τὸ δὲ τρύγα καλοῦσι. τούτων τῷ μὲν ἑτέρῳ τὴν ξανθὴν χολήν, τῷ δ΄ἑτέρῳ τὴν μέλαιναν εἰκάζων οὐκ ἂν ἁμάρτοις …²³⁸

Imagine, then, some new wine which has been not long ago pressed from the grape, and which is fermenting and undergoing alteration through the agency of its contained heat. Imagine next two residual substances produced during this process of alteration, the one tending to be light and air-like and the other to be heavy and more of the nature of earth; the one, as I understand, they call the flower and the other the lees. Now you may correctly compare yellow bile to the first of these, and black bile to the latter …

tr. Brock

It is a tiresome job, that of being a mortal being. First of all, one has to continually consume food in order to survive – for a short while, that is. Second of all, the consumption of food requires all kinds of secondary processes, which deal with the necessary by-products of the alteration of food into nourishing blood, and which in turn require their specific organs and processes, with which again all kinds of things could go wrong, leading to a fatal disease or disorder!

Galen, in this passage, distinguishes two of these necessary by-products, each with their own distinguishing characteristics. The comparison of black bile with the lees of wine is familiar from At. Bil. Here too, its production is clearly depicted as a by-product of the digestive system similar to those by-products produced with fermentation. These metaphors or analogies that Galen repeatedly gives, that of the lees of wine, but also that of the watery part that runs out of olives when they are pressed, make it clear that black bile is understood as a by-product of a process that is aimed at making something different. What is essential in these processes, is the oil, the wine or the blood. These simply happen to be hard to get. First, the watery, yeasty, slimy residue needs to be evacuated from these useful substances. Indeed, as we saw, the providence of the demiurge helps us out here:

οὔκουν ἂν ἠμέλησεν ὁ δημιουρὸς τῶν τοιούτων ζῷων ἐκκαθαίρειν τοῦ αἵματος, ὅσον ἰλύς τις αὐτοῦ καὶ τρύξ ἐστι, καθάπερ οὐδὲ τὸ πικρόχολόν τε καὶ ὀρρῶδες περίττωμα.²³⁹

The crafter of these animals, just as it did not neglect to cleanse out of the blood all the sediment and dreg, just so it did with its bilious and serous residue.

This process, to get rid of the residues caused by the digestive process, already starts from the very inception of the human being. Even when we are still a foetus, not yet in possession of our own functional system of evacuation in the form of a fully operational spleen, nature is already getting rid of the bilious residue of the blood for us:

ἐν γὰρ τῇ κυήσει τὸ χρηστότατον ἑλκούσης αἷμα τῆς διαπλαττούσης καὶ αὐξανούσης τὸ κύημα φύσεως, ὑπολείπεται τὸ μοχθηρότατον ἐν ταῖς φλεψὶν, ὅ μετὰ τὴν ἀποκύησιν ἀποκρίνεται, καθάπερ ἐν ἑκάστῳ μηνὶ τὸ περιττόν τε καὶ ἄχρηστον, οὐ κατὰ τὸ ποσὸν μόνον, ἀλλὰ καὶ κατὰ τὸ ποιόν· ὅπερ ὡς τὸ πολὺ μελάντερόν ἐστι τοῦ κατὰ φύσιν ἔχοντος αἵματος.²⁴⁰

The nature that shapes and augments the embryo during pregnancy draws the most useful blood and leaves behind in the veins the worst blood, which is secreted after birth like each month the superfluous and obsolete blood, not only with respect to quantity but also with respect to quality; this blood indeed is much darker than the blood we naturally have.

Even while still in the womb, black bile is separated out of the blood that is used to shape the foetus, and left behind in the body of the mother, who takes care of its evacuation. Before we are born, our mothers deal with the consequences of our need for nourishment. This indicates that there is no moment for a human being in which black bile is not produced as a by-product or residue of the processes that ensure its survival. And this by-product is always dangerous. As Galen remarks in UP, nature made sure that the organs involved in digestion have small nerves that perceive causes of pain, so that these can be disposed of. He then says that if these organs were not able to perceive in such a way, ‘they would all, I think, be easily ulcerated, eaten away, and putrefied by the daily supply of residues flowing into them’, since even now, with this capacity in function and the organs equipped to get rid of acrid and pungent residues straight away, they are still ‘ulcerated, abraded, eroded and putrefied by pure bile, either yellow or black’.²⁴¹ It is a finely balanced organism, our body, and in its very own depths continuously lurk detrimental substances out to destroy it.

Galen mentions yellow and black bile together here, as dangerous residues. In Nat. Fac., as we have seen, the yellow bile is also defined as another residue besides the black bile, but analogous to what is called the ‘flower’ in wine-production. The two residues are described in opposite terms. The yellow bile is light and air-like. That is to say, of such quality that it would tend upward towards the heavens. The black bile is, as usual, described rather as heavy and earth-like, that is to say, of such nature that it would tend downward towards the earth. Thus, in the production of these residues, the digestive system displays a kind of vertical cosmological schema, a reproduction of the entire elemental gamut, to which we shall return in the next paragraph. For now, let us also recall that blood, the production of which is the essential aim of the digestive system, has an exceptional position among the humours and is considered to be ‘well-mixed’ or a mixture of all the humours, that is to say: a mean.²⁴² In fact, in one passage in Nat. Fac., Galen defines the other humours as the result of a disproportionate amount of innate heat in the veins:

ἀποδέδεικται γὰρ ἐκείνοις τοῖς ἀνδράσιν ἀλλοιουμένης τῆς τροφῆς ἐν ταῖς φλεψὶν ὑπὸ τῆς ἐμφύτου θερμασίας αἷμα μὲν ὑπὸ τῆς συμμετρίας τῆς κατ΄αὐτήν, οἱ δ΄ ἄλλοι χυμοὶ διὰ τὰς ἀμετρίας γιγνόμενοι …²⁴³

It has been demonstrated by these men that when the nutriment in the veins is altered by the innate heat in the right proportion, blood comes to be, while the other humours come to be because of disproportion.

Here, the humours as such seem to be the result of something gone wrong. This might seem paradoxical, given that Galen also repeatedly emphasizes that we contain all humours at all times. However, Galen expresses this notion in other works as well, and it may simply imply that there is always something going wrong, which does not seem implausible to me at all.²⁴⁴ On the contrary, it seems likely that the amount or intensity of innate heat is normally not perfect. The right amount would vary according to a myriad of factors, such as the type of food that is digested, one’s individual constitution, the season, one’s share of exercise, one’s mental state, the climate etc. Would it always be completely proportionate, this passage seems to suggest, then we would produce only blood and not the other humours.²⁴⁵ There is some precedent for this notion of the humours in Aristotle, as we have seen, but also in Plato’s Timaeus. There is a passage in the Timaeus – again, which Galen knew intimately – in which Timaeus speaks of a blood that has ‘a multitude of colors and bitter aspects’, and that will contain ‘bile and serum and phlegm of every sort’. This is a specific kind of blood in the story of Timaeus: it has received waste from flesh that is in a bad shape. Its description, however, might be close to Galen’s notion of blood as a mixture of the humours (it has a multitude of colors and aspects). The description in the Timaeus of these other humours is extremely negative, they are described as ‘παλιναίρετα’, ‘back-products’ and ‘διεφθαρμένα’, ‘agents of destruction’, which do not supply the body with any nourishment. They are ‘hostile to one another’ and ‘wage a destructive and devastating war’ against the parts of the body that are properly functioning.²⁴⁶ Elsewhere, Galen approvingly quotes the passage from the Timaeus in which Timaeus differentiates between two kinds of serum (ἰχὼρ), one being the gentle, watery kind of blood (ὁ μὲν αἵματος ὀρρὸς πρᾷος), the other being the sharp and malignant kind of black bile (ὁ δὲ μελαίνης χολῆς ὀξείας τε ἄγριος).²⁴⁷ Galen, of course, systematizes Plato’s remarks somewhat to fit his humoural theory: what Plato said here, is that black bile is the most harsh (χαλεπώτατος) of the humours, while blood is the most suitable or good (ἐπιεκέστατος). Galen himself never describes the three other humours in such negative terms in such a general way as in the Timaeus, but this particular passage fits very well with his opposition between blood and black bile, his notion of a pure and a mixed blood, and with the exceptionally beneficial nature of blood compared to the other humours. In fact, he also sets out the distinction between these two ways in which the word blood is used in his explanation of the passage from the Timaeus: one is separate from the other humours and the other is mixed with it.²⁴⁸ Certainly, passages such as the one from Nat. Fac. quoted above, do seem to suggest that according to Galen these other humours are produced because it just cannot be helped, rather than because they are so beneficial in themselves. Better beings than ourselves, such as the stars, do not have our humours since they do not need to continuously nourish their constitution in a way that causes by-products. It might well be, in our case, that these humours serve a function within the (digestive) system of our bodies, but that is only already assuming the fundamental imperfection (the continuous need for nourishment) that made their generation necessary in the first place.

But is this idea of something going wrong all the time with our body, as such, not terribly incongruent with Galen’s general teleological framework in which nature produces well-designed beings? Let us have a look at the following passage from UP, Galen’s teleological work par excellence:

μάλιστα μὲν γάρ, εἴπερ οἷόν τ΄ἦν, ἄνευ παντὸς κακοῦ κατεσκεύαστ΄ ἂν ἅπαντα ταῦτα· νυνὶ δέ, οὐ γὰρ ἐνδέχεται τῆς ὕλης φυγεῖν τὴν μοχθηρίαν οὐδεμιᾷ τῶν τεχνῶν οὐδ΄ ἀδαμάντινόν τε καὶ πάμπαν ἀπαθὲς ἐργάσασθαι τὸ δημιούργημα, καταλείπεται κοσμεῖν αὐτὸ τὸν ἐνδεχόμενον κόσμον. ἐνδέχεται δ΄ἄλλον ἄλλη τῶν ὑλῶν· οὐ γὰρ ἐκ τῆς αὐτῆς δήπουθεν οὐσίας τά τ΄ἄστρα γέγονε καὶ ἡμεῖς.²⁴⁹

Surely if it had been possible, she [nature] would have arranged all these matters with no drawbacks at all, but as it is, since it is impossible with all her arts to avoid the inadequacies of her material and to make her creations of adamant, entirely invulnerable, it remains for her to arrange them as best as she can. Different materials admit of different arrangements; for certainly we are not made of the same substance as the stars.

tr. May

Indeed, immediately following this passage, Galen elaborates upon some of these drawbacks. He proceeds to discuss the use, necessity, and manners of alteration and evacuation of the various humours (except for blood, since it is not a περίττωμα). The humours are there because we are not like the stars. This notion of not being like the stars is far from uncommon in Galen, and we shall return to it in the next section. For now, let us focus again on the spleen. Once the melancholic blood has been drawn to the spleen, the potential danger of black bile is not yet resolved. After all, were this the end of it, most of the black bile would just pile up in the spleen itself, presumably leading to a giant cancer and other unspeakable horrors. As we have mentioned above, some of it is altered into nutriment for the spleen itself. The rest is disposed of in the stomach after which it has to be discharged, partly through the vomiting that accompanies nausea and partly through the stools.²⁵⁰ This process of discharge is the normal course of events, it is not merely a description for those that are already affected by an excess of black bile. There needs to be a continuous evacuation of the stuff. Presumably, this entails that our stools normally contain black bile that has been drawn from the blood by the spleen, and has then been evacuated to the stomach after a process of alteration.²⁵¹ When these evacuations are not properly performed and the black bile piles up, melancholy is the result:

καὶ χωρὶς δὲ τῆς τοιαύτης κενώσεως, ἀθυμίας τε καὶ δυσθυμίας μελαγχολικὰς ἐργάζεται …²⁵²

And without this evacuation, despondency and melancholic depression arise.

Melancholy can be a direct result of the inability to neutralize the potentially dangerous side-effects of normal digestive processes due to a weakness of the spleen. That is to say: if it were not for the continuous cleansing activity of our spleen, ceteris paribus, we would be naturally in a state of melancholy. In other words, the spleen is making up for the tragic fact that we are not like the stars.

Before we turn to discuss Galen’s analysis of the condition of melancholy itself, we shall have a final look into the dark substance of its cause, now with less focus on its physiological reality, and more attention for the specific associations it evokes, for what we could call its spectrum of meaning.

2.6 The End of Summer

The season of black bile, the time when it is most predominant, is autumn. Its abundance is prepared in the period before that, in summer, when the days are longest and the sun shines most vigorously, drying and heating everything beneath it. In the summer, blood is still strong in the body, since it is the season following spring, but the bile increases:

τοῦ δὲ θέρος τὸ τε αἷμα ἰσχύει ἔτι καὶ ἡ χολὴ ἀείρεται ἐν τῷ σώματι καὶ παρατείνει ἐς τὸ φθινόπωρον. ἐν δὲ τῷ φθινοπώρῳ τὸ μὲν αἷμα ὀλίγον γίνεται· ἐναντίον γὰρ αὐτῷ ὸ φθινόπωρον τῇ φύσει ἐστίν. ἡ δὲ χολὴ ἡ θερινὴ κατέχει τὸ σῶμα καὶ τὸ φθινόπωρον.²⁵³

In summer blood is still strong, and bile increases in the body and lasts until autumn. In the autumn, the blood becomes small in quantity, since autumn is opposite to it by nature. The bile of summer also dominates the body in the autumn.

tr. Hankinson

The bile remains in autumn, after the heat recedes. As autumn approaches, the amount of blood decreases. The moisture has been driven out because of the heat, and what remains is the abundance of a substance that is dry and has now become cold:

ἐγένετο δ΄ εἰκότως τοιοῦτος διὰ τὸ προκατωπτῆσθαι τοὺς χυμοὺς τῷ θέρει. τὸ δ΄ ὑπόλειμμα τῶν ὀπτηθέντων, ὅταν δηλονότι σβεσθῇ τὸ θερμόν, αὐτίκα γίνεται ψυχρόν τε καὶ ξηρόν, ψυχρὸν μὲν διὰ τὴν τοῦ θερμοῦ σβέσιν, ξηρὸν δέ, ὅτι κατὰ τὴν ὄπτησιν ἐξεδαπανήθη πᾶν τὸ ὑγρὸν ἐξ αὐτοῦ.²⁵⁴

And it is reasonable that such a humour arises as a result of the cooking of the humours during the summer. The residue of this cooking, when the hot has been thoroughly quenched, then becomes cold and dry, cold as a result of the quenching of the heat, dry because the process of cooking has driven out all of the moisture from it.

tr. Hankinson, slightly modified

What we have in autumn, is a kind of remainder of summer, the bile that persists after the sun has departed. In fact, autumn is literally described as the end of summer in ancient Greek: it is composed of a combination of the verb φθίω, ‘to perish, decline, decay, die’ and the word ὀπώρα, ‘summer’ (for which θέρος is more common) or ‘the latter part of summer’ and also ‘fruit’. The combination of these two words designate autumn as a kind of death of summer, or the time when the fruits of summer decay. One might recall Rufus’ words here, saying that excess of heat ‘renders the humours black, just as the sun blackens fruits and human bodies’.²⁵⁵ The notion of excessive heating is already developed in Rufus, but he mostly relates melancholy to spring, rather than the period after summer, which might make more sense in this context of overheating and then cooling down.²⁵⁶ Galen’s rendering of yellow bile being dominant in summer, while black bile already increases then and becomes dominant after summer, seems to have a parallel in the schema presented in a text from the Medical Excerpts by Paul of Aegina, that is there presented as a letter from Diocles (whose work Galen was familiar with) to a king Antigonus. The authenticity of this text is subject to debate, so we cannot be sure if it hails from Diocles himself.²⁵⁷ In this letter, it is noted that after the rising of the Pleiads, which would be around the end of April or early May, yellow bile increases until the summer solstice. The summer solstice, in turn, would have been around the 22nd or 23rd of June, and it is said that after this period the black bile starts to increase until the autumn equinox, which would be around the end of September.²⁵⁸ This corresponds well to the notion that black bile is produced in the latter part of summer so that it is predominant in autumn.

Walter Müri has noted that there is a parallel between the development of black bile as a separate substance – that is to say, the division of ‘bile’ into a yellow and black bile – and an expansion of the number of seasons from three to four – that is to say, the division of summer into summer and autumn. Somewhere in the 6th century, autumn (φθινόπωρον) was added to the already existent χειμών, winter, ἔαρ, spring and θέρος, summer, as the latter part or end of summer.²⁵⁹ This is an interesting parallel indeed, especially considering that yellow and black bile remain so closely related in Galen, and considering that Galen repeatedly remarks that the Greeks, when they speak of χολή, ‘bile’, simply, refer to the yellow bile, whereas if they want to indicate the black bile, the word for bile needs to be further specified with the additional μέλαινα, ‘black’.²⁶⁰ That is to say, just as there previously was only a summer and there is now a summer and an end or decay of summer, there previously was only bile, while there now is also a degenerated bile that is a remnant of an excess of heat.

One notices that there is something negative or privative about the description of autumn: it is primarily understood as a negation of what precedes it.²⁶¹ The description of its coming to be is remarkably similar to the production of black bile itself, which comes to be when, during digestion, there is too much innate heat so that instead of blood, black bile is produced. Likewise, in summer, there is excessive heat so that the amount of blood diminishes and that of black bile increases. Clearly, since fruits and summers are generally good things, this description implies a negative characterization of autumn, just as Galen sees the production of black bile as a deviation from the production of blood. The mere fact that this production is common, does not make it less of a deviation in this sense.

Another thing to note in this regard is that the qualities of black bile and of autumn are coldness and dryness. These are – in this specific combination – the qualities of death as well, since that is what we become when we die, or better: it is what the remainder of us becomes, after the life has flowed from our bodies. This is, in fact, a point that is noted by Galen in the context of a presentation of the position of followers of Athenaeus. They apparently claim that one of the four pairings of elemental qualities, hot and wet, is superior to the others, does not cause any illness, and is as such the best mixture and the mixture of life.²⁶² They conclude this on the basis of the characteristics of death, which are the exact opposite:

καὶ μὲν δὴ καὶ τὸν θάνατόν φασιν εἰς ξηρότητα καὶ ψῦξιν ἄγειν τὰ τῶν ζῴων σόματα. καλεῖσθαι γοῦν ἀλίβαντας τοὺς νεκροὺς ὡς ἂν οὐκέτι λιβάδα καὶ ὑγρότητα κεκτημένους οὐδεμίαν, ἐξατμισθέντας θ΄ ἅμα διὰ τὴν ἀποχώρησιν τοῦ θερμοῦ καὶ παγέντας ὑπὸ τῆς ψύξεως.²⁶³

Furthermore, they state that death leads to dryness and cooling in animal bodies; and indeed, [they argue], dead bodies are referred to as corpses (alibas), on the grounds that they no longer possess any moisture (libas) and wetness, having at once lost their vapours because of the departure of the hot, and having been solidified by the cooling.

tr. Singer and van der Eijk

If death is characterized by the qualities of dryness and coldness, then life must be characterized by their opposites, wetness and hotness. Thus, spring is well-tempered, because it ‘consists in nothing other than the domination of these two qualities’, as Galen presents the position of these followers of Athenaeus. Galen himself takes issue with this argument, since spring, according to him, is not characterized by a predominance of hot and wet in the same way in which winter, for example, is characterized by wet and cold. Rather, spring does not possess any of its qualities in a disproportionate sense – this, according to Galen, is what it means to be well-balanced. Galen defines spring rather as a precise middle with regard to all extremes.²⁶⁴ He approvingly quotes from the Hippocratic Aphorisms the saying that ‘Spring is most healthy and least fatal’. But whereas he takes issue with the way spring is characterized by the followers of Athenaeus in terms of the predominance of wetness and hotness, he does not take any issue with their opposition of spring and autumn and their accompanying associations of life and death or health and disease respectively. In fact, he notes a particular problem with autumn – it is most conducive to illness, due to its irregularity of mixture:

καὶ τοῦτο γ΄ ἐστὶ τὸ μάλιστα νοσῶδες ἐργαζόμενον τὸ φθινόπωρον, ἡ ἀνωμαλία τῆς κράσεως. οὐκ ὀρθῶς οὖν εἴρηται ψυχρὸν καὶ ξηρόν, οὐ γάρ ἐστι ψυχρὸν αὐτὸ καθ΄ αὑτὸ θεωρούμενον, ὥσπερ ὁ χειμών, ἀλλὰ τῷ θέρει παραβαλλόμενον ἐκείνου ψυχρότερον. οὐ μὴν οὐδ΄ ὁμαλῶς εὔκρατον, ὡς τὸ ἔαρ, ἀλλ΄ ἐν τούτῳ δὴ καὶ μάλιστα διενήνοχεν ἐκείνης τῆς ὥρας, ὅτι τὴν εὐκρασίαν τε καὶ τὴν ὁμαλότητα διὰ παντὸς ἴσην οὐ κέκτηται.²⁶⁵

And it is this that makes autumn so particularly conducive to sickness: the unevenness of the mixture. It is not, therefore, correctly called cold and dry; for it is not cold when one considers it in itself, like winter, but only colder when compared with summer. Nor, on the other hand, is it evenly well-mixed, like spring, its chief difference from that season being that it does not possess an equal good-mixture and evenness throughout.

tr. Singer and van der Eijk

Again, we find autumn defined in opposition to spring, in clearly negative terms. Whereas spring is well-tempered and evenly balanced, autumn is defined by the absence of these very qualities. Also, it is again defined negatively in terms of its precedent, summer: it is not cold in itself but only compared to summer. This opposition between spring and autumn is the same opposition as the one between blood and black bile, both pairs are opposed because of their respective mixture.²⁶⁶

We noticed earlier that the amount of blood decreases as the amount of bile increases, and that the amount of blood is least in autumn, since ‘autumn is opposite to it by nature’. This was a text that Galen quoted from the Hippocratic On the Nature of Man itself. In his commentary on the Hippocratic text, Galen adds the following:

κατὰ μὲν τὴν πρὸ ταύτης ῥῆσιν εἴρηται ἐν τῷ φθινοπώρῳ τὸ μὲν αἷμα ὀλίγον γίνεσθαι· ἐναντίον γὰρ αὐτοῦ τὸ φθινόπωρον τῇ φύσει ἐστίν. ἡμεῖς δέ, ὅπως ἐναντίον ἐστίν, ἐδιδάξαμεν· εἴπερ γὰρ τὸ μὲν αἷμα θερμὸν καὶ ὑγρόν ἐστιν ὁμοίως τῷ ἦρι, τὸ δὲ φθινόπωρον, ὡς αὐτὸς ἔφη, ξηρόν τέ ἐστι καὶ ψύχειν ἤδη ἄρχεται τὸν ἄνθρωπον, εἰκότως ἐναντίον τέ ἐστι τὸ φθινόπωρον τῷ ἦρι καὶ τὸν χυμὸν ἔχει τὸν ἐναντίον τῷ αἵματι πλεονάζοντα, τὸν ξηρὸν καὶ ψυχρόν.²⁶⁷

In the preceding passage he said that ‘In the autumn, the blood becomes small in quantity, since autumn is opposite to it by nature’; and we will explain in what way it is opposite. For if indeed blood is hot and wet in the same way as spring, then autumn, as he said, is dry, ‘and man already begins to cool down’, and it is reasonable both that autumn is opposite to spring, and involves an excess of the humour opposite to blood, namely one that is dry and cold.

tr. Hankinson, slightly modified

Autumn is opposite to spring and black bile is opposite to blood, by virtue of their respective pairs of elemental qualities being opposites. We noticed earlier, however, that blood has quite an exceptional status among the humours. We saw how Galen considers blood, if not the ‘sole constituent’ of human nature, then at least ‘most closely affiliated to it’ (οἰκειότατος).²⁶⁸ We also noticed how blood is produced when the ideal amount of innate heat is used in the process of digestion, whereas the other humours are produced as by-products when the amount is too great or too small.²⁶⁹ Indeed, blood and spring are attributed by Galen the same exceptional status:

ἔστι μὲν οὖν τις οὐ σμικρὰ ζήτησις καὶ περὶ τῆς τοῦ ἦρος κράσεως, ὅπως λέγεται θερμὸν καὶ ὑγρόν, ἣν διῆλθον ἐπιδεικνὺς ἄμεινον εἶναι λέγειν εὔκρατον αὐτό· καὶ δῆλον ὅτι καὶ τὸ αἷμα κατὰ τὸν αὐτὸν λόγον οὐ θερμὸν καὶ ὑγρόν, ἀλλ΄ εὔρκρατον.²⁷⁰

Yet the investigation concerning the mixture of spring – in what way it is hot and wet – is no trivial one, which I have already covered when I indicated that it is better to call it ‘well-tempered’. And clearly by the same argument, blood too will not be really hot and wet, but well-tempered.

tr. Hankinson

Instead of having a pair of qualities that predominate, like in each of the other humours and seasons, blood and spring are rather described as ‘well-tempered’. In another passage in HNH, Galen makes a comparison between spring and autumn in which he calls spring ‘the best of seasons’ and ‘the only one properly natural, as opposed to the one contrary to nature’.²⁷¹ How odd, that one of the four seasons, which do seem to form a balanced natural order together, is said to be contrary to nature. What does it mean for the black bile itself, that blood and spring are the humour and season that black bile and its season are opposed to? Blood and spring are both defined as exceptionally beneficial, useful, healthy, moderate and close to our nature. If black bile and autumn are opposed to them, their characteristics must, to some extent at least, be opposed to those as well.²⁷² Galen’s commentary on the Hippocratic On the Nature of Man is one of the main texts in which we find this opposition between black bile and autumn on the one hand, and blood and spring on the other. This means that in Galen’s most systematic continuation of Hippocratic humoural theory, black bile is not simply one humour among others. It is the worst of the humours, whereas blood is the best. Moreover, it appears to even be contrary to nature somehow, while at the same time being a part of it. Could it be, that black bile is both part of our nature and simultaneously contrary to it?

As we have noticed, black bile is often described by Galen as the sediment of the blood, as the nasty by-product that one needs to get rid of, like with the lees of wine or the watery part of olives: we are just stuck with those and have to remove them if we want those fine products of wine and olive oil. In the following passage these two opposites are also clearly brought together:

τῶν δὲ χυμῶν ὁ μὲν χρηστότατός τε καὶ οἰκειότατός ἐστι τὸ αἷμα. τούτου δ΄οἷον ὑπόστασίς τις καὶ ἰλὺς ἡ μέλαινα χολή· ταῦτ΄ ἄρα καὶ ψυχροτέρα τ΄ ἐστὶ καὶ παχυτέρα τοῦ αἵματος.²⁷³

Of humours, the most useful and natural is blood. Black bile is a kind of sediment or dreg of this; it is thus colder and thicker than blood.

tr. Singer, modified

Again, blood is the most useful of the humours and the one that is most congenial to us, while black bile is merely a dreg that is carried along by the blood and that needs to be evacuated from it.²⁷⁴ As we have seen above, yellow bile can also be understood as a by-product of the production of blood, and was involved in the same wine-metaphor as black bile. Black bile has much in common with yellow bile and can even be seen as an altered continuation of the same substance, as became clear in the context of the discussion of the seasons and their respective humours, as well as in the context of the dangerous black bile that is a burned yellow bile. However, black bile is in some ways opposed to yellow bile as well. Let us have another look at the passage from Nat. Fac. we quoted earlier:

οἶνον δή μοι νόει γλεύκινον οὐ πρὸ πολλοῦ τῶν σταφυλῶν ἐκτεθλιμμένον ζέοντά τε καὶ ἀλλοιούμενον ὑπὸ τῆς ἐν αὐτῷ θερμασίας· ἔπειτα κατὰ τὴν αὐτοῦ μεταβολὴν δύο γεννώμενα περιττώματα τὸ μὲν κουφότερόν τε καὶ ἀερωδέστερον, τὸ δὲ βαρύτερόν τε καὶ γεωδέστερον, ὧν τὸ μὲν ἄνθος, οἶμαι, τὸ δὲ τρύγα καλοῦσι. τούτων τῷ μὲν ἑτέρῳ τὴν ξανθὴν χολήν, τῷ δ΄ἑτέρῳ τὴν μέλαιναν εἰκάζων οὐκ ἂν ἁμάρτοις …²⁷⁵

Imagine, then, some new wine which has been not long ago pressed from the grape, and which is fermenting and undergoing alteration through the agency of its contained heat. Imagine next two residual substances produced during this process of alteration, the one tending to be light and air-like and the other to be heavy and more of the nature of earth; the one, as I understand, they call the flower and the other the lees. Now you may correctly compare yellow bile to the first of these, and black bile to the latter …

tr. Brock

The descriptions of these residual substances are opposed to each other: yellow bile tends to be light and air-like, whereas back bile is heavy and earthy. Here we have the traditional opposition between heaven and earth associated with the two biles, understood as the two by-products of digestion. What would be the role of the wine itself in this analogy? Obviously, the wine is the essential product, it is what the entire process is about. In the process of digestion, this is the blood. Blood, as we saw, is defined as the well-mixed mean and that which is closest to our nature. Blood holds a perfect middle position between the extremes. In this respect it is interesting to note that Galen on several occasions names wine as a remedy to melancholy. In QAM, he states that the daily consumption of wine relieves us of all sorrow and despondency (λύπης δ΄ ἁπάσης καὶ δυσθυμίας κουφίζει σαφῶς οἶνος πινόμενος).²⁷⁶ Indeed, Galen says this in a context in which he has just given melancholy as an example of the body (i.e. the brain particularly) causing damage to the rational capacities, and he also proceeds to present Zeno of Citium as an example of the beneficial effects of daily wine-drinking (alluding to his reportedly melancholic behaviour when sober).²⁷⁷ It seems there is more to the metaphor than black bile and yellow bile being comparable to the two by-products of the lees and the flower. The essential product, the wine itself, also has the tendency to produce affections in us that are opposed to the ones that black bile produces. Indeed, in another passage, Galen compares the end-product, the wine, to useful blood.²⁷⁸ Clearly, there is a double opposition here, between black bile and blood on the one hand, and between black bile and yellow bile on the other.

Blood, as the mean between those extremes, suits us. Human beings, in the Greek philosophical tradition, are defined as being in between heaven and earth: we are intelligent, like the heavenly bodies, but we do not have a substance as pure as those bodies, since we also consist of water and earth.²⁷⁹ Black bile is the earthy humour, the sediment in the blood, the heavy humour that weighs us down and binds us to the earth – it literally makes us depressed when it predominates. Yellow bile, on the other hand, is associated with the heavenly bodies, it is described as fiery and light, naturally tending in the opposite direction of the black bile, it is dry and hot like the stars.²⁸⁰ Galen also states that it causes intelligence, in a passage in HNH that refers to QAM, where intelligence was said to be caused by dryness, the quality that the stars possess to the extreme.²⁸¹

Black bile is also dry, of course, but its dryness is nothing but a remainder of the heat of summer, as we have seen. It is there when the fire dies out. I think there is no doubt that we here have a link to the traditional relation between thinking and melancholy that we found in Rufus and the Peripatetic tradition as well. Intelligence is at its peak during summer since it is caused by yellow bile, which predominates in summer. But after this peak of activity of the intellect, a low point follows: the heat that inspired intelligence cools and a dark substance that is the cause of melancholy perseveres. Indeed, one might think here of the bipolar-like descriptions of melancholy from the Problemata. The only essential difference is that the cooling and heating of black bile is now further divided over two substances, the dry and hot yellow bile that increases intellectual activity, and the dry and cold black bile that increases sadness. But it might perhaps be more useful to have a somewhat broader association: what is depicted with these different substances is not so much a recurrent bipolar-like disorder that befalls exceptional people, but rather simply the fact that we, as human beings, are beings that relate ourselves in fundamental ways to both heaven and earth. Naturally, both of these extremes would have a place in our physical constitution, naturally we would swing from one to the other regularly, and naturally we would be most at ease when we rather produce that which essentially fits us and is closest to our nature: the mean, i.e. blood. With the transition from summer to autumn, from yellow bile to black bile, our substances change from something that is more similar to the heavenly bodies to something that is more similar to earth, as if portraying the course of a falling star which loses its heat as it descends. As we have seen, Galen considers black bile as one of the ‘drawbacks’ of the fact that nature needs to work with a matter that makes it impossible to make us like the stars, which are predominantly dry and hot. Likewise, we have argued how Aristotle attributed to the melancholic’s constitution a particular sensitivity for the fact that we are not divine but composite beings. Both in Aristotle and in Galen the heavenly bodies serve as the embodiment of the divine par excellence, and in Galen black bile is the substance that is most opposed to the stars. In fact, it has the qualities of a star that has fallen to earth: it used to be hot, and therefore it is dry, but then it cooled down and therefore it blackened and now resembles thick earth. Galen links the very presence of residues such as black bile in our body to a necessary constraint presented to creative nature by matter. The fact of this matter implied certain drawbacks: it made it so that divine nature could not make us like the stars, as he remarks.²⁸² That is to say, the fact that we are not capable of a divine life and are in a state of pain qua living beings – again, an idea that we previously found in Aristotle in the context of his discussion of melancholy – could be related in Galen to the fact that our matter determines that we cannot not be like the heavenly bodies. Indeed, this is what Galen says in UP:

μὴ τοίνυν, ὅτι καλῶς ἥλιός τε καὶ σελήνη καὶ τῶν ἄλλων ἄστρων ὁ χορὸς ἅπας διατέτακται, θαυμάσῃς, μηδ΄ἐκπλήξῃ σε τὸ μέγεθος αὐτῶν ἢ τὸ κάλλος ἢ τὸ τῆς κινήσεως ἀκατάπαυστον ἢ ἡ τῶν περιόδων τάξις, ὥστε τὰ τῇδε παραβάλλοντα σμικρὰ δοκεῖν εἶναι καὶ ἀκόσμητα· καὶ γὰρ σοφίαν καὶ δύναμιν καὶ πρόνοιαν ὁμοίαν εὑρήσεις ἐνταυθοῖ. σκόπει γάρ μοι τὴν ὕλην, ἐξ ἧς ἕκαστον ἐγένετο, καὶ μὴ μάτην ἐλπίσῃς ἐκ καταμηνίου καὶ σπέρματος ἀθάνατον δύνασθαι συστῆναι ζῷον ἢ ἀπαθὲς ἢ ἀεικίνητον ἢ λαμρὸν οὕτω καὶ καλόν, ὡς ἥλιον.²⁸³

Then do not wonder so greatly at the beautiful arrangement of the sun, moon, and the whole chorus of stars, and do not be so struck with amazement at the size of them, their beauty, ceaseless motion, and ordered revolutions that things here on earth will seem trivial and disorganized in comparison; for here too you will find displayed the same wisdom, power, and foresight. Consider well the material of which a thing is made, and cherish no idle hope that you could put together from the catamenia and semen an animal that would be deathless, exempt from pain, endowed with never-ending motion, and as radiantly beautiful as the sun.

tr. May

Here, the limitations of the human being compared to the heavenly bodies are explained in terms of the stuff we are made of: blood and semen. From these materials nature can only create a being in need of nourishment, which suffers pain and death, a being which lacks the light of the heavenly bodies and their unceasing motion. Black bile is one of the necessary residues of this nourishment, and seems to embody this fact of human life with its particular characteristics. It is the most heavy and earthlike humour, the one most opposed to the heavens; it is the darkest substance, lacking the light of the heavenly bodies more than anything else; it is the substance associated with death and mortality because of its qualities of coldness and dryness; and it is the most obstinate and immovable of the humours (as we shall see below).²⁸⁴

Both in Aristotle and Galen man is understood as a being that is essentially imperfect in contrast to the divine, which, in turn, is embodied by the stars. Moreover, this imperfection is associated with the addition of ‘another element’, which the melancholics and the black bile seem to have a special relationship with, and which is rather opposed to the substance of the divine embodied in the heavenly bodies.²⁸⁵ Since we are not entirely divine, not of a star-like substance only, we suffer from the tension of being suspended between heaven and earth.

The transition from yellow bile to black bile, at the end of summer, embodies the course of this suspension, and gives its vertical hierarchy a place in the natural and regular passing of time. Therefore, this is also the time when blood, as the ideal mean, needs to be most absent. This transition from the predominance of a more heavenly substance to the predominance of the earthy black bile, happens in the time after which blood was predominant, and derails when blood recedes more and more. Then we come down, as it were, from resembling the substance of the stars closest when yellow bile is most predominant, being dry and hot, fiery and having our intellect at its peak, until we have reached the bottom of dark, cold, thick earth, risking sadness and despondency. According to the same analogy, black bile is dominant in the time of life after our prime (ἡ παρακμή), again a period which is literally defined negatively with regard to the preceding period, which is also the best period.²⁸⁶ Black bile is the residue of our ceaseless but natural attempts to approach the heavens, to soar up high towards the sun, since it is that part of the bile that persists after the fire that renders us intelligent periodically quenches. In this manner, the change of the seasons expresses in time a paradox (that of the suspension between heaven and earth) that is inherent to our constitution. Indeed, persistence is one of the major associations with black bile in Galen. This correlates to the thick, sediment-like nature of its substance, as well as to its association with earth. But it also manifests itself in other ways, as we can see from some of the following quotations:

ἀρότερον μὲν γὰρ διῃτημένου φλεγματωδέστερος ἀθροίζεται χυμός, ἐν πόνοις δὲ πλείοσιν ἤτοιπακρόχολος ἢ μελαγχολικός, ἐν θέρει μὲν πικρόχολος, ἐν φθινοπώῳ δὲ μελαγχολικός. ἀλλὰ καὶ τῶν πόνων τὸ μῆκος ἐπισκεπτέον· ὅσῳ γὰρ ἂν ὦσι πολυχρονιώτεροι, τοσῷδε μᾶλλον ἐπὶ τὸ μελγαχολικὸν ἐκτρέπονται.²⁸⁷

When a person’s life is quite idle, a more phlegmatic humor collects. In greater exertions, it is either picrocholic or melancholic – in summer, picrocholic and in autumn, melancholic. But one must also consider the length of the labours, for the longer they are in duration, the more the tendency is toward the melancholic.

tr. Johnston

The longer the length of labours, the more melancholic one becomes. Now, one might say: well, that is because endless labour is bound to make one sad, but I think the issue here is not so much about a relation between labour and a psychological state that is melancholic, but rather between lengthiness or perseverance and black bile. Black bile is ponderous and heavy, it stays the same for a long time, static and unmoved. We can see this also in the description of so-called quartan fevers that Galen quotes in his commentary on the Hippocratic On the Nature of Man (though Galen himself seems to not quite agree with it). These fevers last longest of all kinds, which is explained in terms of its subject having relatively less yellow and more black bile:

προσγίνεται δὲ αὐτοῖσιν ἀοὸ μελαίνης χολῆς τὸ περισςὸν τοῦτο καὶ δυσαπάλλακτον· μέλαινα γὰρ χολὴ τῶν ἐν τῷ σώματι ἐνεόντων χυμῶν γλισχρότατον καὶ τὰς ἕδρας χρονιωτάτας ποιεῖ. γνώσῃ δὲ τῷδε, ὅτι οἱ τεταρταῖοι πυρετοὶ μετέχουσι τοῦ μελαγχολικοῦ.²⁸⁸

This excessiveness and tenacity in them derives from black bile. For black bile is the most viscous of the humours of the body, and the one which remains unmoved for the longest time. You will understand from the following that quartan fevers have a share of the melancholic.

tr. Hankinson

Black bile remains unmoved longest. Likewise, in Hipp. Elem., Galen says that black bile is δυσκίνητος, ‘difficult to move’, ‘obstinate’.²⁸⁹ The physical properties of the black bile itself are also translated into the psychological domain, where black bile is said to cause a kind of firmness or constancy of soul:

ἔστι δὲ καὶ ἕτερος τις λόγος φυσικὸς οὐ σμικρὰν ἔχων πιθανότητα, καθ΄ ὅν εἰς ἠθῶν ἐπιτηδείων γένεσιν οἱ τέσσαρες ἀποδείκνυνται χυμοὶ χρήσιμοι. προαποδεῖξαι δὲ χρὴ πάλιν ἐν αὐτῷ ταῖς τοῦ σώματος κράσεσιν ἑπόμενα τὰ τῆς ψυχῆς ἤθη, περὶ οὗ καὶ ἡμῖν ἑτέρωωθι γέγραπται. τούτου τοίνυν ὑποειμένου τὸ μὲν ὀξὺ καὶ συνετὸν ἐν τῇ ψυχῇ διὰ τὸν χολώδη χυμὸν ἔσται, τὸ δ΄ ἑδραῖον καὶ βέβαιον διὰ τὸν μελγχολικόν, τὸ δ΄ ἁπλοῦν καὶ ἠλιθιώτερον διὰ τὸ αἷμα· τοῦ δὲ φλέγματος ἡ φύσις εἰς μὲν ἠθοποίΐαν ἄχρηστος, ἀναγκαίαν δὲ φαίνεται τὴν γένεσιν ἔχον ἐν τῇ πρώτῃ μεταβολῇ τῶν σιτίων.²⁹⁰

There is also another physical account which has no little plausibility, according to which the four humours are proved to be effective in the generation of the states of character which are appropriate to them. In it we first need to establish that the states of character of the soul are consequent upon the mixtures of the body, about which we have written elsewhere. On this basis sharpness and intelligence in the soul will exist as a result of the bilious humour, steadfastness and firmness as a result of the melancholic, simplicity and artlessness as a result of the blood. The nature of phlegm is ineffective with regard to the prediction of character, having as it evidently does its necessary generation in the first alteration of the food.

tr. Hankinson, slightly modified

Galen describes each of the humours as the cause of certain psychic states, except for phlegm. The words he chooses to describe the states caused by black bile show an interesting resemblance with its physical associations. They both suggest a kind of stability, as of something that stays the same, which fits with the thick and earthy nature of black bile. The word ἑδραῖος mostly means something like ‘sitting’ or ‘sedentary’. It is also used for the horse-back on which a rider sits and can mean ‘steady’ or ‘steadfast’ as well. Finally, it is related to the word ἕδος, ‘seat’ or ‘abode’, which is the regular epithet of Earth in Hesiod’s Theogony (ἕδος ἀσφαλὲς αἰεί).²⁹¹ Likewise, βέβαιος means ‘firm’ or ‘steady’. We also find both words together in Galen’s commentary on the Epidemics, as adjectives with ὕπνος to describe a very deep sleep.²⁹² The description fits well with the notion that black bile is the part of bile that stays throughout summer and autumn, remaining after the hotness recedes, and with the notion that black bile is most difficult to purge. Yellow bile is said to be the cause of intelligence here, and of a ‘sharpness’ in the soul, which fits its light, thin, dry, hot and fiery nature that is more akin to the heavenly bodies, which are supremely intelligent. The description of blood is more remarkable, as it seems rather negatively to come down to simplicity or even a kind of foolishness of the soul.²⁹³ I have not found any parallels for it in Galen, nor elsewhere in earlier authors. It seems likely that this description is based on the predominant wetness that is characteristic of blood. In QAM (to which the above passage quoted from HNH refers), Galen is not as specific on the humours as he is in other works and is more focused on the role of the elemental qualities, but he does present wetness as the cause for a lack of intelligence, while dryness is presented as the cause for intellect.²⁹⁴ Blood is one of the two wet humours. Moreover, since phlegm is left out of the picture in the passage cited from HNH, blood is the only wet humour in this schema, which would make it suitable to fulfil a role opposite to that of dry yellow bile as the cause of intelligence, black bile being the persisting residue of this yellow bile.

With this passage from HNH, however, we are already discussing the psychological rather than the physiological domain, which we might take as a testimony of how closely the two are interrelated when it comes to Galen’s humoural theory in general and to black bile and melancholy in particular. But before we discuss this psycho-somatic interrelation further, we shall discuss melancholy separately, to some extent, in the same way we discussed the black bile separately, and we shall briefly summarize our findings on black bile in Galen.

2.7 Conclusion on Black Bile

The ambiguity between black bile as an exceptional and unnatural substance that causes disease, and black bile as a regular part of our constitution, is not so much solved in Galen’s work, as it is fully retained and embraced. Galen makes a rather consistent distinction between these two kinds of black bile. However, at the same time, as we have seen, the two have much in common, are often difficult to distinguish, and the one can alter into the other. So much so, that there is, according to Galen, no need to apply different names to them. We have seen how, in Galen’s work, this enigmatic and many-headed black bile, which was previously mostly seen as a useless residue or as something which, as an altered form of a normal substance, caused disease, has now become firmly integrated into a fourfold schema of humours, elemental qualities, elements, seasons and phases of life. Within that schema, black bile has a place of its own, which makes it a part of our nature and the grander order of things, while it remains, at the same time, a substance that forms a continuous threat to that very order itself. The necessity of this threat is generated by another necessity: that of the restrictions that matter imposes on the creative capacity of nature. Given the qualities of this matter, we cannot be like the stars and need continuous nourishment in order for our ephemeral existence to continue. Black bile is the worst and most dangerous by-product of the process of digestion, which is aimed towards the production of a beneficial mean: blood. Not only is black bile opposed to our most well-tempered and beneficial substance, it is also opposed to yellow bile. Yellow bile is related to summer, fire, the heavens, an upward movement, activity and intelligence. Black bile is related to the end of summer, an extinguished fire, the earth, a heavy downwards movement, and static and obstinate passivity. In its opposition to blood, black bile is opposed to life, in its opposition to yellow bile, it is opposed to the stars and the divine.

It is necessary for us to produce such a substance, given what we are. We are not only living and not only divine after all, we are also mortal and of the earth. Therefore, we cannot be without the substance of black bile, but we also need our spleen to continuously neutralize it, so that it will not take us over and weigh us down. In Galen, black bile is both opposed to our nature, as well as a necessary part of it. As such, it fits the general tendency in Greek philosophy to define the human being in terms of something that it is not completely, but only partly. The rational capacity for the perception of the eternal is what defines us most, and it is what we should actualize in order to fulfil our nature – in Galen just as well as in Plato²⁹⁵ – but this capacity is limited in two senses that are interrelated and of which black bile becomes the physiological paradigm in Galen: our mortality and our matter. With black bile, we mortal beings carry our own negation with us, as if the remnant of our own life is always already inside us. I think, from the perspective of the role black bile plays in Galen’s cosmology, Burton was right to say melancholy is an expression of the sense of our mortality, and Diderot was right to say it is a sense of our own imperfections.²⁹⁶ But the association of mortality with earth and darkness is primordial, and was there before black bile became a regular part of our constitution in Galen’s writings. From this perspective, I think Kudlien’s suggestions still make sense, and Galen’s definitive incorporation of black bile into our nature builds on a range of implicit associations with darkness, night, death, earth etc.²⁹⁷ Given the typically ancient Greek notion of man as a being suspended between earth and heaven, aspiring to the latter but tragically bound to the former, there should also be a dark, obstinate and detrimental substance inside our very bodies, a substance opposed to the vital juices that maintain us, mixed together with them. There should be something in us that is more threatening and destructive than blood, that useful and nourishing substance, and that weighs down the part of us that is fiery and tends upwards to the stars, the yellow bile. With this incorporation of black bile into the cosmological order of things and into our very body – the two form a continuum after all in Galen²⁹⁸ – the dangerous potency of black bile, and notably therefore also of melancholy itself, is normalized to a certain extent, incorporated into our nature despite its unnatural potency. We shall pursue this theme of normalization of black bile and melancholy in the next chapter, in which we shall focus on melancholy in Galen.