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Bloodletting (or blood-letting) is the deliberate withdrawal of blood from a patient to prevent or cure illness and disease. Bloodletting, whether by a physician or by , was based on an ancient system of medicine in which blood and other bodily fluids were regarded as "Humorism" that had to remain in proper balance to maintain health. It was the most common medical practice performed by surgeons from Ancient history until the late 19th century, a span of over 2,000 years. In Europe, the practice continued to be relatively common until the end of the 19th century.B.) Anderson, Julie, Emm Barnes, and Enna Shackleton. "The Art of Medicine: Over 2,000 Years of Images and Imagination Hardcover." The Art of Medicine: Over 2,000 Years of Images and Imagination: Julie Anderson, Emm Barnes, Emma Shackleton: : The Ilex Press Limited, 2013. The practice has been abandoned by modern-style medicine for all except a few very specific medical conditions. In the beginning of the 19th century, studies had begun to show the harmful effects of bloodletting.
The modern term phlebotomy refers to the drawing of blood for laboratory analysis or blood transfusion. Therapeutic phlebotomy refers to the drawing of a unit of blood in specific cases like hemochromatosis, polycythemia vera, porphyria cutanea tarda, etc., to reduce the number of red blood cells. The traditional medical practice of bloodletting is considered a pseudoscience, though the method is still commonly used in forms of alternative medicine.
In Greece, bloodletting was in use in the 5th century BC during the lifetime of Hippocrates, who mentions this practice but generally relied on Dieting. Erasistratus, however, theorized that many diseases were caused by plethoras, or overabundances, in the blood and advised that these plethoras be treated, initially, by exercise, Perspiration, reduced food intake, and vomiting. But his student Herophilus supported bloodletting. A contemporary Greek physician, Archagathus, one of the first to practice in Rome, also believed in the value of bloodletting.
"Bleeding" a patient to health was modeled on the process of menstruation. Hippocrates believed that menstruation functioned to "purge women of bad humors". During the Roman Empire, the Greek physician Galen, who subscribed to the teachings of Hippocrates, advocated physician-initiated bloodletting.
The popularity of bloodletting in the classical Mediterranean world was reinforced by the ideas of Galen, after he discovered that not only but also artery were filled with blood, not air as was commonly believed at the time. (1998). 067440355X, Harvard University Press. 067440355X (1995). 9780521381352, Cambridge University Press. ISBN 9780521381352 There were two key concepts in his system of bloodletting. The first was that blood was created and then used up; it did not circulate, and so it could "stagnate" in the extremities. The second was that Humorism balance was the basis of illness or health, the four humors being blood, phlegm, black bile, and yellow bile, relating to the four Greek classical elements of air, water, earth, and fire respectively. Galen believed that blood was the dominant humor and the one in most need of control. In order to balance the humors, a physician would either remove "excess" blood (plethora) from the patient or give them an emetic to induce vomiting, or a diuretic to induce urination.
Galen created a complex system of how much blood should be removed based on the patient's age, constitution, the season, the weather and the place. "Do-it-yourself" bleeding instructions following these systems were developed. Symptoms of plethora were believed to include fever, apoplexy, and headache. The blood to be let was of a specific nature determined by the disease: either arterial or venous blood, and distant or close to the area of the body affected. He linked different with different organs, according to their supposed drainage. For example, the vein in the right hand would be let for liver problems and the vein in the left hand for problems with the spleen. The more severe the disease, the more blood would be let. Fevers required copious amounts of bloodletting.
Even after the humoral system fell into disuse, the practice was continued by surgery and Barber surgeon. Though the bloodletting was often recommended by physicians, it was carried out by barbers. This led to the distinction between physicians and surgeons. The red-and-white-striped pole of the barbershop, still in use today, is derived from this practice: the red symbolizes blood while the white symbolizes the bandages. Bloodletting was used to "treat" a wide range of diseases, becoming a standard treatment for almost every ailment, and was practiced prophylaxis as well as therapeutically.
A number of different methods were employed. The most common was phlebotomy, or venesection (often called "breathing a vein"), in which blood was drawn from one or more of the larger external veins, such as those in the forearm or neck. In arteriotomy, an artery was punctured, although generally only in the temples. In scarification (not to be confused with scarification, a method of body modification), the "superficial" vessels were attacked, often using a syringe, a spring-loaded Scalpel, or a glass cup that contained heated air, producing a vacuum within (see fire cupping). There was also a specific bloodletting tool called a scarificator, used primarily in 19th century medicine. It has a spring-loaded mechanism with gears that snaps the blades out through slits in the front cover and back in, in a circular motion. The case is cast brass, and the mechanism and blades steel. One knife bar gear has slipped teeth, turning the blades in a different direction than those on the other bars. The last photo and the diagram show the depth adjustment bar at the back and sides.
could also be used. The withdrawal of so much blood as to induce syncope (fainting) was considered beneficial, and many sessions would only end when the patient began to swoon.
William Harvey disproved the basis of the practice in 1628, and the introduction of scientific medicine, la méthode numérique, allowed Pierre Charles Alexandre Louis to demonstrate that phlebotomy was entirely ineffective in the treatment of pneumonia and various fevers in the 1830s. Nevertheless, in 1838, a lecturer at the Royal College of Physicians would still state that "blood-letting is a remedy which, when judiciously employed, it is hardly possible to estimate too highly", and Louis was dogged by the sanguinary Broussais, who could recommend leeches fifty at a time. Some physicians resisted Louis' work because they "were not prepared to discard therapies 'validated by both tradition and their own experience on account of somebody else's numbers'."
During this era, bloodletting was used to treat almost every disease. One British medical text recommended bloodletting for acne, asthma, cancer, cholera, coma, convulsions, diabetes, epilepsy, gangrene, gout, herpes, indigestion, insanity, jaundice, leprosy, ophthalmia, plague, pneumonia, scurvy, smallpox, stroke, tetanus, tuberculosis, and for some one hundred other diseases. Bloodletting was even used to treat most forms of hemorrhaging such as nosebleed, excessive menstruation, or hemorrhoidal bleeding. Before surgery or at the onset of childbirth, blood was removed to prevent inflammation. Before amputation, it was customary to remove a quantity of blood equal to the amount believed to circulate in the limb that was to be removed.Carter (2005) p. 6
There were also theories that bloodletting would cure "heartsickness" and "heartbreak". A French physician, Jacques Ferrand wrote a book in 1623 on the uses of bloodletting to cure a broken heart. He recommended bloodletting to the point of heart failure (literal).Lydia Kang MD & Nate Pederson, Quackery: A Brief History of the Worst Ways to Cure Everything "Bleed Yourself to Bliss" (Workman Publishing Company; 2017)
Leeches became especially popular in the early 19th century. In the 1830s, the French imported about 40 million leeches a year for medical purposes, and in the next decade, England imported 6 million leeches a year from France alone. Through the early decades of the century, hundreds of millions of leeches were used by physicians throughout Europe.Carter (2005) p. 7
Bloodletting was also popular in the young United States of America, where Benjamin Rush (a signatory of the Declaration of Independence) saw the state of the arteries as the key to disease, recommending levels of bloodletting that were high even for the time. George Washington asked to be bled heavily after he developed a throat infection from weather exposure. Within a ten-hour period, a total of 124–126 ounces (3.75 liters) of blood was withdrawn prior to his death from a throat infection in 1799. The Permanente Journal Volume 8 No. 2: The asphyxiating and exsanguinating death of president george washington , p. 79, Spring, 2004, retrieved on 11 November 2012 One reason for the continued popularity of bloodletting (and purging) was that, while anatomy knowledge, surgical and diagnostic skills increased tremendously in Europe from the 17th century, the key to curing disease remained elusive, and the underlying belief was that it was better to give any treatment than nothing at all. The psychological benefit of bloodletting to the patient (a placebo effect) may sometimes have outweighed the physiological problems it caused. Bloodletting slowly lost favour during the 19th century, after French physician Dr. Pierre Louis conducted an experiment in which he studied the effect of bloodletting on pneumonia patients. A number of other ineffective or harmful treatments were available as placebos—mesmerism, various processes involving the new technology of electricity, many potions, tonics, and elixirs. Yet, bloodletting persisted during the 19th century partly because it was readily available to people of any socioeconomic status.
Barbara Ehrenreich and Deirdre English write that the popularity of bloodletting and heroic medicine in general was because of a need to justify medical billing. Traditional healing techniques had been mostly practiced by women within a non-commercial family or village setting. As male doctors suppressed these techniques, they found it difficult to quantify various "amounts" of healing to charge for, and difficult to convince patients to pay for it. Because bloodletting seemed active and dramatic, it helped convince patients the doctor had something tangible to sell. (2026). 9781400078004, Anchor Books. ISBN 9781400078004
Some researchers used statistical methods for evaluating treatment effectiveness to discourage bloodletting. But at the same time, publications by Philip Pye-Smith and others defended bloodletting on scientific grounds.
Bloodletting persisted into the 20th century and was recommended in the 1923 edition of the textbook The Principles and Practice of Medicine. The textbook was originally written by Sir William Osler and continued to be published in new editions under new authors following Osler's death in 1919.
Bloodletting was once thought to reduce inflammation, boost immunity, and improve circulation by aiding in the detoxification of the blood circulating throughout the body. Over time, however, bloodletting's harmful impacts made the practice a less preferable form of medicine. Not only was bloodletting generally ineffective, it also commonly led to significant blood loss. High loss of blood made patients highly susceptible to infection/sepsis or the formation of a hematoma. Additionally, bloodletting also caused anemia, leading the patient to feel weak, tired, or even go unconscious. The harmful effects did not stop there; in severe cases, bloodletting had the potential to cause deadly hypovolemic shock. As the medical world advanced, these deadly effects made the practice of bloodletting fade in popularity.
According to Helena Miton et al.'s analysis of the HRAF database and other sources, there are several cross-cultural patterns in bloodletting.
In a transmission chain experiment done on people living in the US through Amazon Mechanical Turk, stories about bloodletting in a non-affected area were much more likely to transition into stories about bloodletting being administered near the area in pain than vice versa. This suggests that colocalized bloodletting could be a cultural attractor and is more likely to be culturally transmitted, even among people in the US who are likely more familiar with non-colocalized bloodletting.
Bloodletting as a concept is thought to be a cultural attractor, or an intrinsically attractive / culturally transmissible concept. This could explain bloodletting's independent cross-cultural emergence and common cross-cultural traits.
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