Elemental My Dear Physician

February 2025 | Vol. 69, No. 1
Written by Sam Garloff, DO

This issue of the JPOMA highlights the history of the profession, as we have just experienced the 150th anniversary of the AOA. Our association, POMA, originated in 1903 and remains a vibrant division of the AOA. PCOM, the oldest of the DO schools in Pennsylvania, began as the Philadelphia College and Infirmary of Osteopathy in 1899. Today, in addition to the Philadelphia campus it offers the DO degree in Georgia. In my hometown of Erie, LECOM is a major force in medical care offering multiple career choices at campuses in Pennsylvania, New York and Florida. Osteopathic education is now available at Duquesne and soon at IUP.

“The times they are a changin”- Bob Dylan… or are they?

Let’s look back at the origins of medicine. In 450 B.C., Empedocles, a Greek philosopher, defined fire, earth, air, and water as the elemental “roots of life”. A century later, Aristotle in his writing, “On the Heavens”, added a fifth element, aether, to explain the stars.

Aristotle went on to define the elements as indivisible building blocks.  “An element, we take it, is a body to which other bodies may be analyzed, present in them potentially or in actuality…and not itself divisible into bodies different in form. That, or something like it, is what all men in every case mean by element”.

Although a philosophical construct, faith in the importance of elements extended well into the 18th century which lead to their importance in medicine. Hippocrates and later Galen, felt the elements were mirrored in the human body, consisting of four humors: yellow bile, or fire; black bile, or earth; blood, or air; and phlegm, or water.

An individual’s health and well-being depended on keeping the humors in balance through such measures as enemas and blood-letting. They believed the following. An outgoing person had an excess of blood or a sanguine nature; excess phlegm lead to reserved or phlegmatic behavior; black bile lead to melancholy; yellow bile triggered anger or irrational behavior.

The four humors were then connected to the four seasons. Spring could trigger an excess of blood; summer, yellow bile; autumn, black bile; and winter, phlegm. By the 17th century questions were raised about these beliefs but the humoral theories lasted into the early 19th century. There were of course other explanations for medical difficulties in Ancient Greece. The Pythagoreans looked for medical diagnostics and treatments in terms of numbers and music. These shockingly primitive concepts, viewed in light of today’s medical knowledge, lead to shockingly accurate observations when compared to today’s medical knowledge and understandings.

Interestingly, the power of belief in the elements led to musical compositions still held in high esteem today. Consider Antonio Vivaldi’s, “Le Quattro Stagioni”, translated as “The Four Seasons”. You may think of it as the musical score of the movie, Kramer vs Kramer.

Thank goodness all of that is now safely in our past.  Never again will such nonsense enter into the scientific mind. As modern physicians we have advanced well past such primitive and illogical concepts, practices and theories.

After all, who among us would consider diagnosing Seasonal Affective Disorder?

WGRP, over and out.