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No longer were diseases defined in supernatural terms; rather, they were caused by something
inside
the body—specifically, an imbalance of bodily fluids called humors. Hippocrates, the father of medicine, named these humors yellow bile, black bile, phlegm, and blood, likening them to four colors (yellow, black, white, and red), four elements (fire, earth, water, and air), four seasons (summer, autumn, winter, and spring), four organs (spleen, gall bladder, lungs, and liver), and four temperaments (choleric, melancholic, phlegmatic, and sanguine). Because diseases were caused by an imbalance of humors, treatments were designed to balance them, most prominently bloodletting, enemas, and emetics (drugs that induce vomiting). Malaria wasn’t caused by a parasite; it was the result of excess yellow bile from hot summer weather. Epilepsy wasn’t linked to abnormal brain activity; it was caused by too much phlegm blocking the windpipe. Cancer wasn’t caused by an uncontrolled growth of cells but by the accumulation of black bile. Inflammation didn’t stem from a vigorous immune response; it was caused by too much blood (hence bloodletting).
    Two hundred years later, in the second century B.C., Chinese healers embraced a similar concept, reasoning that diseases were caused by an imbalance of energies. Chinese healers treated this imbalance by placing a series of thin needles under the skin (acupuncture). However, because Chinese physicians were prohibited from dissecting human bodies, they didn’t know that nerves originated in the spinal cord. In fact, they didn’t know what nerves were. Or what the spinal cord was. Or what the brain was. Rather, they interpreted events inside the body based on what they could see outside, like rivers andsunsets. Chinese physicians believed that energy flowed through a series of twelve meridians that ran in longitudinal arcs from head to toe, choosing the number twelve because there are twelve great rivers in China. To release vital energy, which they called
chi
, and restore normal balance between competing energies, which they called
yin
and
yang,
needles were placed under the skin along these meridian lines. The number of acupuncture points—about 360—was determined by the number of days in the year. Depending on the practitioner, needles were inserted up to four inches deep and left in place from a few seconds to a few hours.
    And that’s pretty much the way things stood until the late 1700s. Practitioners continued to offer therapies based on religious notions of divine intervention or Greek notions of balancing humors or Chinese notions of balancing energies. (Some, such as purgatives, acupuncture, aromatherapy, crystal healing, enemas, magnet therapy, hydrotherapy, and faith healing, are still around today.) But of all the therapies rooted in ancient beliefs, none was more widespread or universally embraced in the eighteenth century than bloodletting. European doctors bled their patients twice a month. Barbers, too, were perfectly willing to bleed their customers. (The red-and-white barber pole represents a white bandage wrapped around a bloody arm.) In the United States, Benjamin Rush, a well-respected Philadelphia physician and signer of the Declaration of Independence, was a big proponent of bloodletting. Rush was so influential that when George Washington suffered epiglottitis (inflammation of the flap of tissue that sits on top of the windpipe), his doctors chose bloodletting instead of the tracheotomy that might have saved his life. Five pints of blood—about half histotal blood volume—were taken from Washington as he struggled to breathe. On December 14, 1799, George Washington, a man who had survived smallpox and bullet wounds, went into shock—killed by bloodletting. Sir William Osler, cofounder of Johns Hopkins Hospital, in Baltimore, delivered a fitting postscript. “Man knew little more at the end of the eighteenth